课件：双相障碍的诊治及临床病例分享.ppt

* DSM-IV 对轻躁狂的诊断标准过于严格，要求有躁狂的全部症状表现以及持续至少4天。实际上，轻躁狂最常见的持续时间只有1–3天。并且，患者通常不认为轻躁狂是其疾病的表现。询问家庭成员/有关系的其他人有助于做出准确诊断。据报道，家庭成员发现轻躁狂症状的可能性是患者自己发现症状可能性的2倍 (分别为47%和22%)。1 未能发现轻躁狂常常导致将双相II型障碍患者误诊为重性抑郁障碍。研究表明，30–50%的重性抑郁病例实际上是双相II型障碍。并且，最终筛查双相障碍阳性的患者中，80%的人在前面的就诊检查中没有得到正确诊断。2 由于患者的精神病合并症比较多见，造成症状重叠，这也是造成双相II型障碍诊断不足和误诊的原因。 参考文献 1. Bowden CL. Psychiatr Serv 2001;52:51-55.2. Hirschfeld RM, et al. J Clin Psychiatry 2003; 64:53-59. * Risks of Misdiagnosis in Bipolar Disorder The risk is high without a diagnosis or an incorrect diagnosis due to incorrect or nonexistent therapy. Suicide rates among those with bipolar disorder average 0.4% per year. This value is more than 20-fold higher than that observed in the general population. Bipolar patients with a history of suicide attempts are the population at highest risk for suicidal behavior. The course of the disease is a risk factor with those with major depressive episode patterns, rapid cycling, and mixed episodes at highest risk. Race (Caucasians), age (adolescents and the elderly), and marital status (unmarried, especially without dependents) are other risk factors. * The response to treatment can also provide clues to the differentiation of unipolar and bipolar. In contrast to unipolar depression, treatment response to bipolar disease is characterized by an abrupt onset of antidepressant effect, an early loss of response, and increased agitation/mixed state. Personal Communication: RH Perlis, MD. Ghaemi SN, Lenox MS, Baldessarini RJ. Effectiveness and safety of long-term antidepressant treatment in bipolar disorder. J Clin Psychiatry. 2001;62:565-569. Nierenberg AA, Feinstein AR. How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. JAMA. 1998;259:1699-1702. * Unipolar vs Bipolar Depression There is no consistent and reliable difference in depressive symptomatology between bipolar disorder and unipolar depressed patients. However, patients with unipolar depression are