"The medication compliance of such patients is poor, and the phenomenon of not taking the drug on time or stopping the drug on time is relatively common, resulting in poor treatment effect, so it is very necessary to implement individualized treatment for patients with bipolar disorder from taking the drug to stopping the drug." Professor Li Wenbiao, head of the Neuropsychiatric Group of the Therapeutic Drug Monitoring and Research Professional Committee of the Chinese Pharmacological Society and director of the Clinical Laboratory Department of Beijing Anding Hospital affiliated to Capital Medical University, said at the expert exchange meeting held during the "World Bipolar Disorder Day" on March 30 that patients with bipolar disorder have two symptoms of depression and mania, and must achieve precise treatment and take drugs scientifically. At the same time, due to various reasons such as large side effects of psychotropic drugs and large individual differences in drug efficacy, the medication compliance of such patients is often not high, and the clinical need to regularly monitor the therapeutic drug concentration to evaluate the treatment effect of patients, promote accurate medication, and improve patient compliance and medication safety.
Professor Li Wenbiao, Director of the Clinical Laboratory Department of Beijing Anding Hospital
Poor patient medication adherence affects efficacy
With the increasing pressure of urban people to work and live, the incidence of bipolar affective disorder is increasing. Especially under the continuous impact of the new crown epidemic, the mental health problems of the Chinese people have become more and more prominent. Bipolar disorder is a common affective disorder in which patients may experience depression, mania, and other manifestations, and severe cases may kill themselves or harm others.
Data show that the average incidence of bipolar disorder worldwide is 2%-3%, and some countries or regions can be as high as 5%-7%. At present, about 60 million people worldwide are affected by bipolar disorder, while the incidence of bipolar disorder in mainland China has increased year by year, and the number of people affected has reached 8.4 million. The famous artist Van Gogh, jin Xiaoyu, the protagonist of the article "Our Genius Son" that was popular on the Internet some time ago, suffered from this emotional disorder.
Although the prevalence of "bipolar disorder" is not low, and the incidence is increasing year by year, the public is still quite unfamiliar with "bipolar disorder". Bipolar disorder is divided into two disease states of mania and depression, alternating, the main manifestation of mania is high emotions, active thinking, and impulsive behavior; in depression, it is manifested as low mood, sometimes accompanied by anxiety, helplessness, and despair, and extreme people can have suicidal ideas, and even commit suicide. Bipolar disorder is a chronic disease. Patient treatment includes medication, psychotherapy, behavior modification, and physical therapy. Among the many treatment methods, drug treatment is still the most important means at present, and it is also the basic treatment. However, the most difficult clinical problem is the problem of medication compliance in such patients.
Patients with bipolar disorder receive medication with no efficacy and no adverse reactions, efficacy with adverse reactions, efficacy is not obvious but there are adverse reactions, and there are no obvious adverse reactions. Professor Li Wenbiao explained that this is due to the fact that the drugs used for the treatment of bipolar disorder have large individual differences in pharmacokinetics and pharmacodynamics, small treatment index, and many adverse reactions, and many patients will stop the drug because of the disadvantages.
Mass spectrometry laboratories required for therapeutic drug monitoring
Therapeutic drug monitoring facilitates individualized therapy
"Therefore, it is necessary to implement individualized treatment for patients with bipolar disorder. We can use therapeutic drug monitoring (TDM) to accurately grasp the dosage and improve their compliance. Professor Li Wenbiao said.
"Through TDM, first of all, it can help doctors observe the performance of drug effects, help to individualize the adjustment of drug dosage, and improve the effective rate of drug treatment." Secondly, the toxic side effects of psychotropic drugs are often relatively large, and often require combination of drugs, once the toxic side effects occur, doctors can adjust the dosage of drugs through monitoring, which can effectively reduce adverse reactions. In addition, through the monitoring of therapeutic drugs, doctors can help judge the compliance of patients taking drugs, on the one hand, to prevent self-stop of medication, on the other hand, to prevent patients from overtaking drugs, resulting in drug poisoning. Professor Li Wenbiao said. For example, once a patient feels that he or she has recovered and wants to stop the drug, he can use therapeutic drug monitoring to confirm whether it is really suitable for discontinuation.
Therapeutic drug monitoring (TDM) is essential for patients with bipolar disorder. Domestically, however, this work has not yet reached the level of universality, and it is still mainly limited to the level of provincial mental health centers. According to the "2018 Survey on the Monitoring of Therapeutic Drugs in Chinese Hospitals", 38% of the 463 hospitals participating in the survey carried out TDM, mainly concentrated in large and medium-sized urban hospitals, and there are still many problems in practical work.
Beibei Zhao, director of Guangzhou Jinyu Mass Spectrometry Clinical Testing Center
"Therapeutic drug monitoring is mainly distributed in hospitals in large and medium-sized cities, and it is related to its own technical requirements." Zhao Beibei, director of the Guangzhou Jinyu Mass Spectrometry Clinical Testing Center, said that the main detection technologies for therapeutic drug monitoring include immunology technology, high performance liquid chromatography, and liquid chromatography tandem mass spectrometry. Due to the high price of such equipment, dependence on imports, and strong professionalism, special professionals are required to operate and use, which limits the large-scale application of this technology in medical institutions to a certain extent.
According to Jinyu medical data, many patients use antipsychotic drugs at the same time as under-medication (not reaching the effective concentration) and drug overdose. For example, in the amisulpride tablets test for the treatment of schizophrenia, 57% of the samples were above the reference range or above the warning (drug overdose), while the other test for quetiapine, which had a sedative effect, had low concentrations in 39% of the samples.
"In fact, at present, in the whole process of treatment of patients with mental disorders, the monitoring of therapeutic drugs has gradually become an important part. Before the initial formulation of the drug plan, provide drug gene testing to provide a basis for clinicians in the selection and dosage of drugs; enter the treatment stage, provide therapeutic drug concentration detection and report interpretation services, optimize individualized treatment plans, thereby improving clinical efficacy, ensuring patient treatment compliance, and benefiting patients. Zhao Beibei said.
[Reporter] Ou Xujiang
【Author】 Ou Xujiang
Healthy living circle