| 要約: | Objective: Bipolar disorder (BD) is a serious mental disorder causing not only
suffering and disability, but also substantial economic burden. Costs of
hospitalization represent the largest share of direct illness cost. Several clinical
guidelines recommend stimulus reduction (SR) during the treatment of patients
hospitalized for mania. To date, however, no clinical trials have investigated the
efficacy of SR in mania. In this pilot study, we examined the effect of training
inpatient staff to use systematic SR on length of stay (LOS) of our patients.
Method: This was a controlled intervention study of adult patients hospitalized due to
an acute manic episode (ICD-10 criteria). Treatment as usual (TAU) (N=37) was compared
with treatment after systematic training of staff in SR (N=34). LOS was the primary
outcome. Young Mania Rating Scale (YMRS), Montgomery-Åsberg Depression Rating
Scale (MADRS) and Clinical Global Impression (CGI) at admission and discharge were
also measured.
Results: During hospitalization the YMRS, MADRS and CGI improved significantly in
both groups, indicating symptom remission during treatment. The LOS in the TAU was
26.9 days (SD 12.2) and in the SR 28.4 days (SD 11.7). No significant differences
emerged in LOS or in clinical outcome measures between the groups.
Conclusions: To our knowledge, this is the first study evaluating the use of SR during
hospitalization for acute manic episode. Systematic training of staff in SR did not
shorten LOS. Effectiveness of SR during hospitalization remains unclear, and further
studies are needed to clarify the role of SR in treatment guidelines.
Bipolar disorder (BD) is a serious and long-lasting mood disorder causing considerable
suffering and disability (1). Hospital admission is generally required in both acute
manic episode and severe depressive episode with suicidal ideation or plans (2).
Although BD patients spend a longer time in depression than in mania during the course
of their illness (3,4), from an economic standpoint mania appears to be the primary
cost driver in BD hospitalizations (2). Therefore, any intervention in manic patients
that could reduce the need for hospitalization, or shorten the length of stay (LOS)
during inpatient treatment, would have a major effect on diminishing the suffering of
patients and costs of hospitalization (5).
When treating mania or hypomania, several treatment guidelines recommend a calm
environment and stimulus reduction (SR) (6,7,8). SR includes, for instance, increasing
the amount of sleep and limiting activity. To date, however, no studies have
investigated the effectiveness of SR in patients hospitalized due to acute manic
episode.
The aim of our pilot study was to perform a controlled intervention trial to
investigate the effect of training staff in the use of systematic SR (SSR group) in
treating hospitalized patients with an acute manic episode, and to compare this with
treatment as usual (TAU group) during acute manic episode. We hypothesized that the
use of SR in treatment would shorten LOS in the inpatient ward.
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