Pharmacological treatment profiles in the FACE-BD cohort: An unsupervised machine learning study, applied to a nationwide bipolar cohort

JOURNAL OF AFFECTIVE DISORDERS

卷:286

Article

Brodeur, Sebastien⁷  Terrisse, Hugo¹²  Pouchon, Arnaud⁷  Godin, Ophelia¹  Aouizerate, Bruno³  Aubin, Valerie¹⁰  Bellivier, Frank²  Belzeaux, Raoul⁵  Bougerol, Thierry⁷  Courtet, Philippe⁴  Dubertret, Caroline¹¹  Gard, Sebastien³  Haffen, Emmanuel¹³  Henry, Chantal¹⁴  Leboyer, Marion¹  Olie, Emilie⁴  Roux, Paul^8,9  Samalin, Ludovic^15,16  Schwan, Raymund⁶  Etain, Bruno²  Bosson, Jean-Luc¹²  Polosan, Mircea⁷ 

[1] Hop Univ H Mondor, AP HP, DHU PePSY, Pale Psychiat & Addictol, Creteil, France

[2] GH St Louis Lariboisiere Fernand Widal, AP HP, Pole Neurosci, Paris, France

[3] Hop C Perrens, Ctr Expert Trouble Bipolaire, Serv Psychiat Adulte, Pole 3-4-7, Bordeaux, France

[4] CHRU Montpellier, Dept Urgence & Post Urgence Psychiat, Montpellier, France

[5] Hop St Marguerite, Pole Psychiat Addictol & Pedopsychiat, Marseille, France

[6] Hop Brabois, CHU Nancy, Serv Psychiat & Psychol Clin, Vandoeuvre Les Nancy, France

[7] CHU Grenoble & Alpes, Serv Univ Psychiat, Grenoble, France

[8] Ctr Hosp Versailles, Serv Univ Psychiat Adultes, Le Chesnay, France

[9] Serv Psychiat, Le Chesnay, France

[10] Ctr Hosp Princesse Grace, Monaco, Monaco

[11] Hop Louis Mourier, AH PH, Dept Psychiat, Colombes, France

[12] Univ Grenoble Alpes, TTMC IMAG, Grenoble, France

[13] Univ Franche Comte, Serv Psychiat, CHU Besancon, Lab Neurosci, Besancon, France

[14] Univ Paris 05, Pole Hosp Univ Paris 15eme, GHU, Ctr Hosp St Anne, Paris, France

[15] CHU Clermont Ferrand, Pole Psychiat, Clermont Ferrand, France

[16] CHU Clermont Ferrand, Serv Psychiat Adulte B, Ctr Expert Trouble Bipolaire, Clermont Ferrand, France

关键词: Bipolar disorder;    Maintenance treatment;    Mood stabilizers;    Unsupervised machine learning;    Functioning;   

DOI  :  10.1016/j.jad.2021.02.036

来源: Elsevier

【 摘 要 】

Background: Despite thorough and validated clinical guidelines based on bipolar disorders subtypes, large pharmacological treatment heterogeneity remains in these patients. There is limited knowledge about the different treatment combinations used and their influence on patient outcomes. We attempted to determine profiles of patients based on their treatments and to understand the clinical characteristics associated with these treatment profiles. Methods: This multicentre longitudinal study was performed on a French nationwide bipolar cohort database. We performed hierarchical agglomerative clustering to search for clusters of individuals based on their treatments during the first year following inclusion. We then compared patient clinical characteristics according to these clusters. Results: Four groups were identified among the 1795 included patients: group 1 (heterogeneous n = 1099), group 2 (lithium n = 265), group 3 (valproate n = 268), and group 4 (lamotrigine n = 163). Proportion of bipolar 1 disorder, in groups 1 to 4 were: 48.2%, 57.0%, 48.9% and 32.5%. Groups 1 and 4 had greater functional impact at baseline and a less favorable clinical and functioning evolution at one-year follow-up, especially on GAF and FAST scales. Limitations: The one-year period used for the analysis of mood stabilizing treatments remains short in the evolution of bipolar disorder. Conclusions: Treatment profiles are associated with functional evolution of patients and were not clearly determined by bipolar subtypes. These profiles seem to group together common patient phenotypes. These findings do not seem to be influenced by the duration of disease prior to inclusion and neither by the number of treatments used during the follow-up period.

【 授权许可】

Free