%0杂志文章%@ 2368-7959 %I JMIR出版物%V 8% 卡塔尔世界杯8强波胆分析N 4% P e24522 %T使用机器学习估算结果评估双相情感障碍患者的药物依赖自残风险:比较有效性研究%A Nestsiarovich,Anastasiya Kumar,Praveen Lauve,Nicolas Raymond Hurwitz,Nathaniel G %A Mazurie,Aurélien J %A Cannon,Daniel C %A Zhu,Yiliang Nelson,Stuart James Crisanti,Annette S %A Kerner,Berit Tohen,Mauricio Perkins,Douglas J %A Lambert,Christophe Gerard全球健康中心，内科，新墨西哥大学健康科学中心，915 Camino de Salud NE, Albuquerque, NM，美国，1 5052729709，cglambert@unm.edu %K双相情感障碍%K情绪%K躁狂%K抑郁%K药物治疗%K自残%K自杀%K机器学习%K心理治疗%D 2021 %7 21.4.2021 %9原始论文%J JMIR Ment健康%G英语%X背景:行政索赔数据中不完整的自杀性编码是观察性研究的已知障碍。由于数据中缺失了大多数负面结果，评估预防双相情感障碍(BD)自残的治疗策略(包括药物治疗和心理治疗)的证据具有挑战性。关于药物依赖自残风险的研究数据相互矛盾，关于单一疗法和药物联合治疗的预防效果存在很大的不确定性。目的:本研究的目的是比较所有常用的双相障碍药物治疗，以及心理治疗的自残风险，在大量的商业保险人群中，使用自残归因来克服美国电子医疗记录中这一结果被低估的已知局限性。方法:IBM MarketScan管理索赔数据库用于比较BD患者在65个药物治疗方案和无药物治疗期间的自残风险。可能的但未编码的自残事件通过机器学习进行估算，并在敏感性分析中检查不同的概率阈值。比较对象包括锂、稳定情绪的抗癫痫药(MSAs)、第二代抗精神病药(SGAs)、第一代抗精神病药(FGAs)和五类抗抑郁药。建立了具有时变协变量的Cox回归模型，用于个体治疗方案和任何药物治疗，包括或不包括心理社会干预(“心理治疗”)。 Results: Among 529,359 patients, 1.66% (n=8813 events) had imputed and/or coded self-harm following the exposure of interest. A higher self-harm risk was observed during adolescence. After multiple testing adjustment (P≤.012), the following six regimens had higher risk of self-harm than lithium: tri/tetracyclic antidepressants + SGA, FGA + MSA, FGA, serotonin-norepinephrine reuptake inhibitor (SNRI) + SGA, lithium + MSA, and lithium + SGA (hazard ratios [HRs] 1.44-2.29), and the following nine had lower risk: lamotrigine, valproate, risperidone, aripiprazole, SNRI, selective serotonin reuptake inhibitor (SSRI), “no drug,” bupropion, and bupropion + SSRI (HRs 0.28-0.74). Psychotherapy alone (without medication) had a lower self-harm risk than no treatment (HR 0.56, 95% CI 0.52-0.60; P=8.76×10-58). The sensitivity analysis showed that the direction of drug-outcome associations did not change as a function of the self-harm probability threshold. Conclusions: Our data support evidence on the effectiveness of antidepressants, MSAs, and psychotherapy for self-harm prevention in BD. Trial Registration: ClinicalTrials.gov NCT02893371; https://clinicaltrials.gov/ct2/show/NCT02893371 %M 33688834 %R 10.2196/24522 %U https://mental.www.mybigtv.com/2021/4/e24522 %U https://doi.org/10.2196/24522 %U http://www.ncbi.nlm.nih.gov/pubmed/33688834