心境障碍(英文)

精神病学Affective(mood)DisordersXIEGuang-rongM.D.DefinitionAffectivedisordersarecharacterizedbyobviousandpersistentelationordepressionofmood.Themooddisturbanceiscommonlyassociatedwithcognitiveandbehavioralchanges.Inseverecases,psychoticsymptoms,suchashallucinationanddelusion,maybeobserved.Thereisarecurrenttendency.Incertaincases,anepisodemaybecomechronicandresidualsymptomsareobserved.TheClassificationofAffectiveDisordersManicepisode(mania)Depressionsingleepisode(unipolar)recurrentepisodeWithorAffectivewithoutDisordersBipolar-I(withmania)PsychoticBipolarBipolar-II(withhypomania)symptomdisordersMixedtypeRapid-cyclingbipolardisorderDysthymiaCyclothymiadisorderClinicaldescriptionofmooddisordersTheepisodeSeverityMild,moderate,orsevereTypeDepressive,manic,mixedSpecialfeaturesWithmelancholicsymptomsWithneuroticsymptomsWithpsychoticsymptomsWithagitationWithretardationorstuporThecourseUnipolarorbipolarAetiologyPredominantlyreactivePredominantlyendogenousEtiologyGeneticCausesFamilyStudies:InastudyattheNationalInstituteofMentalHealth,25%ofrelativesofbipolarprobandswerefoundtohavebipolardisorderorunipolarillness(depression)themselves,comparedto20%ofrelativesofunipolarprobandsand7%ofrelativesofcontrolsubjects.Somedatahavesupportedmultifactorialmodels,Thesemodelsimplymultiplefactors:genetic,environmental,orboth.Analternativeexplanationisheterogeneity.Inotherwords,singlemajorgenesareimportantinatleastsomefamilies,butitisnotthesamegeneineachfamily.Twinstudies:Onaverage,MZtwinpairsshowconcordance65%ofthetime,andDZtwinpairsshowconcordance14%ofthetime.AdoptionStudies:Inonestudy,theriskforaffectivedisorderinthebiologicalrelativesofbipolarprobandswas31%asopposedto2%intherelativesofcontrolprobands.Theriskinbiologicalrelativesofadoptedbipolarprobandswassimilartotheriskinrelativesofbipolarprobandswhowerenotadoptedaway(26%).Adoptiverelativesdidnotshowincreasedrisk.Adoptionstudiesthatusedabroaderclassofaffectiveprobandsshowedevidenceforgeneticfactorsbutalsopossibleenvironmentalinfluences.MolecularGeneticsLinkageStudiesChromosomalLocationReference18pBerrettinietal19Stineetal199521qStraubetal1994Detera-Wadleighetal1996Xq26Pekkarinenetal199511p15Egelandetal1987Kelsoeetal1991Gurlingetal19955qCoonetal19934pBlackwoodetal199618qFreimeretal1996Stineetal1995Other(including10p,12q)Craddocketal1994Ewaldetal1995Ginnsetal1996NIMHGeneticsInitiative1997SummaryThelifetimeriskforsevereaffectivedisorderisabout8%.Riskisincreasedtoabout20%infirst-degreerelativesofunipolarpatientsandto25%infirst-degreerelativesofbipolarpatients.Riskappearstobe40%inrelativesofschizoaffectivepatients.Therisktooffspringoftwoaffectivelyillparentsismorethan50%.Overallriskfiguresappeartoberisinginrecentyears.BiologicaltheoriesNeurotransmitters.Wenowknowthatallclinicallyeffectiveantidepressantsincreaseneurotransmitterconcentrationsatpostsynapticreceptorsitesbyinhibitingtheirreuptake(intothepresynapticneuron)fromthesynapticcleft,Thisactionhasledtothehypothesisthatdepressioniscausedbyaneurotransmitterdeficiencyandthatantidepressantsexerttheirclinicaleffectbytreatingthisimbalance.Theserotonin-norepinephrine-gluco-corticoidlinkhypothesisofaffectivedisorders.Neuroendocrinefactors.Thetwoendocrinesystemsmostextensivelystudiedinpsychiatryarethehypothalamic-pituitary-adrenal(HPA)axisandthehypothalamic-pituitary-thyroid(HPT)axis.Abouthalfofpatientswithmajordepressionexhibitcortisolhypersecretionthatreturnstonormaloncethedepressioniscured.LifeeventsRecentevidenceconfirmsthatcruciallifeevents,particularlythedeathoflossofalovedone,canprecedetheonsetofdepression.However,suchlossesprecedeonlyasmallnumberofcasesofdepression.Fewerthan20%ofindividualsexperiencinglossesbecomeclinicallydepressed.Theseobservationsarguestronglyforapredisposingfactor,possiblygenetic,psychosocial,orcharacterologicalinnature.DepressiveepisodeDefinitionThedisorderischaracterizedbydepressedmoodthatisoutofkeepingwiththecircumstances.Itmayvaryfromlowmoodtomelancholia,orevenstupor.Inseverecases,psychoticsymptoms,suchasdelusionsandhallucinations,maybepresent.EpidemiologySymptomsanddisordersofthedepressionspectrumarerathercommon.Lifetimeprevalenceratesfordepressivesymptomsare13%~20%andformajordepressivedisorder3.7%~6.7%.Majordepressivedisorderisabouttwotothreetimesascommoninadolescentandadultfemalesasinadolescentandadultmales.Inprepubertalchildren,boysandgirlsareaffectedequally.Ratesinwomenandmenarehighestinthe25-to44-year-oldagegroup.Signs&SymptomsMajordepressiveepisodeThecardinalfeatureofamajordepressiveepisodeisadepressedmoodorthelossofinterestorpleasurethatpredominatesforatleast2weeksandcausessignificantdistressorimpairmentintheindividual’ssocial,occupational,orotherimportantareasoffunctioning.1.Depressedmood.Depressedmoodisthemostcharacteristicsymptom,occurringinover90%ofpatients.Thepatientusuallydescribeshimselforherselfasfeelingsad,low,empty,hopeless,gloomy,ordowninthedumps.Thequalityofmoodislikelytobeportrayedasdifferencefromanormalsenseofsadnessorgrief.Thephysicianoftenobserveschangesinthepatient’sposture,speech,faces,