| Objective:To remind the clinical selection of treatment plan should follow the principle of order,so as to provide a reference for the clinical selection of quetiapine monotherapy in the treatment of acute phase of bipolar depression.Methods:100 patients with first treatment bipolar disorder who were treated in a tertiary grade A psychiatric hospital in Anhui from March 2019 to March 2021 were selected,and randomly divided into drug control group and drug research group,50 cases/group.According to the randomized controlled double blind clinical trial design scheme,the study group was treated with quetiapine,and the control group was treated with lithium carbonate sustained-release tablets.Both groups of patients were treated for 8 weeks.The efficacy of the two groups was evaluated by 17 Hamilton Depression Rating Scale(HAMD-17),Pittsburgh Sleep Quality Index(PSQI)before intervention and 2,4,6,8weeks after treatment,Beck Ravensen Mania Scale(BRMS)at 2,4,6,8 weeks after treatment,TESS at 1,2,4,6,8 weeks after treatmentand,and the Quality of Life Comprehensive Assessment Questionnaire(GQOLI-74)before and 8 weeks after treatment.The two groups of patients completed the monitoring of relevant indicators of the "Temperature,Pulse,Respiratory and Blood Pressure Record Sheet" every day.Blood routine,urine routine,blood biochemistry and electrocardiogram were completed in both groups at 1,2,4,6 and 8 weeks before and after treatment.Both groups completed the full set of thyroxine detection before treatment.The blood drug concentration of the study group was measured at 2,4,6,8 weeks after treatment.The blood lithium concentration of the control group was detected once a week.Results:The study group took quetiapine orally and the control group took lithium carbonate sustained-release tablets orally.100 patients completed the whole 8-week treatment without shedding.There was no significant difference between the two groups in the scores of HAMD-17,PSQI and GQOLI-74 before the intervention(P>0.05).There was no difference in TESS between the two groups at 1 and 2 weeks after intervention(P>0.05).After 8 weeks of treatment,there was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).At 2,4,6,8weeks after treatment,the HAMD-17 score,score reduction rate and PSQI score of the study group were significantly lower than those of the control group(P<0.05).The BRMS score of the two groups did not exceed 5 points after treatment,and with the extension of intervention time,the BRSS score of the two groups patients showed a downward trend,and the score difference in different time periods was statistically significant(P<0.05).TESS in the study group was significantly lower than that in the control group at2,4,6 and 8 weeks after treatment,with a statistically significant difference(P<0.05).The GQOLI-74 score of the study group was significantly higher than that of the control group at 8 weeks after treatment,with a statistically significant difference(P<0.05).After 8 weeks of treatment,the total clinical effective rate{(significant+effective)/n * 100%} in the study group was significantly higher than that in the control group,with a statistically significant difference(P<0.05).In the study group,by repeated analysis of variance,the effect of blood drug concentration on the number of adverse reactions was significant(P<0.05).The correlation analysis between the blood drug concentration of 38 patients in the study group(significantly effective+effective)and the score reduction rate of HAMD-17 showed that the blood drug concentration of quetiapine was positively correlated with the score reduction rate(r=0.781,P<0.001),and the blood drug concentration was about 120-260ng/ml with the strongest correlation with the score reduction rate,when the reduction rate ≥ 50%,the plasma concentration is about 170-260ng/ml.Conclusions:Quetiapine monotherapy is used for the first treatment of depressive episode of bipolar disorder.compared with lithium carbonate monotherapy,quetiapine has the advantages of significantly improving depressive symptoms,rapid onset,significant improvement in sleep and quality of life,and good tolerance.The effective concentration of quetiapine for the first treatment of the acute phase of bipolar depression is about 170-260ng/ml.Quitiapine is commonly used to treat early sleepiness,dizziness,constipation and tachycardia,and its incidence is related to the drug concentration. |
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