Lähteenvuo et al¹ present an analysis of Finnish national registers with the question of which psychotropic drugs reduce the need for rehospitalization in people with bipolar disorder. Psychiatry is currently seeing a wave of such analyses, which, in part, might reflect the limitations of randomized clinical trials (RCTs). While RCTs are considered to be the gold standard because only randomization can rule out both known and unknown confounders, their limitations include trial populations that are not representative of the real world, trials that are typically short term, and outcomes that, in RCTs focused on the maintenance of patients with chronic disease, include only worsening of symptoms rather than full-blown rehospitalization. The analyses of national cohorts overcome these problems by examining all patients in 1 country who are followed up for several years, who can then contribute to very large sample sizes.

Lähteenvuo等¹目前对芬兰国家注册簿进行的分析涉及以下问题：哪种精神科药物可以减少躁郁症患者再次住院的需要。精神病学目前正在看到一波这样的分析浪潮，这在某种程度上可能反映了随机临床试验（RCT）的局限性。尽管RCT被认为是黄金标准，因为只有随机化才能排除已知和未知的混杂因素，但它们的局限性包括不能代表现实世界的试验人群，通常是短期的试验以及RCT中关注的结果慢性病患者的维护仅包括症状恶化，而不是全面的住院治疗。