因自杀行为而就诊的躯体变形障碍1例报告（英文）

概述:对治疗伴自杀行为的躯体变形障碍(body dysmorphic disorder,BDD)的病例报道较少。本文报道了一位患有BDD的19岁男性患者,两年来认为自己面部变丑,这一信念逐渐加重,几乎达妄想程度。然而,他最初被误诊为抑郁障碍,部分原因是他企图自杀,当时存在抑郁症状和社会退缩。后来经证实,这些症状是继发于BDD的。经过8周住院治疗,采用氟西汀和认知行为治疗相结合,患者的症状彻底改善,社会功能也恢复正常。这一病例提醒我们,自杀行为和意念有多方面原因;为了避免误诊和不恰当的治疗,临床医生只有在排除其它可能的原因后才能推断自杀行为和意念是抑郁症的直接结果。本文也讨论了自1886年Enrico Morselli首度报道BDD后,在理解BDD和BDD的诊断标准上的诸多变化。     

抑郁障碍患者自杀行为研究进展

自杀是抑郁障碍的常见并发症,同时也是抑郁障碍患者的主要死亡原因之一,本文对国内外抑郁障碍患者自杀行为的流行病学特点、相关因素等方面的研究进行了综述.     

躯体变形障碍共病其他精神障碍的研究进展

躯体变形障碍(BDD)是一种对想象或轻微外表缺陷的先占观念,该病多与其他精神障碍共病甚至多重共病,尤以抑郁障碍、焦虑障碍、强迫障碍、进食障碍及精神分裂症较多。共病患者通常症状重、病程长、治疗效果及预后差。临床中,由于医护人员及患者对该病的认识和重视不足,常会忽略对BDD的诊断而导致疗效不理想。本文总结了近年来对BDD与其他精神障碍共病和治疗的研究进展并对未来的研究提出了建议。     

抑郁障碍患者下丘脑—垂体—肾上腺轴的功能与自杀行为的关系(英文)

背景目前对抑郁障碍患者自杀行为的神经-内分泌研究仍较少,且结果多不一致。目的探讨国内抑郁障碍患者下丘脑-垂体-肾上腺(hypothalamus-pituitary-adrenal,HPA)轴释放功能与自杀行为的关系。方法比较14例2个月内有过自杀行为的抑郁障碍患者(抑郁研究组)和15例不伴自杀行为的抑郁障碍患者(抑郁对照组)的HPA轴功能。以地塞米松抑制试验(dexamethasone suppression test,DST)、一天中血浆皮质醇浓度的昼夜变化(在帕罗西汀治疗前及治疗6周后评估)以及治疗前和治疗后的24小时尿17-羟皮质醇和24小时尿游离皮质酮,评估HPA轴释放功能。同时以汉密顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评定抑郁严重程度。另外测定15名无抑郁障碍的健康体检者的白天皮质醇浓度。结果抑郁研究组与抑郁对照组之间24h尿皮质醇浓度的差异无统计学意义,尿皮质醇浓度差异也无统计学意义。治疗前两组血浆皮质醇的午夜分泌低谷均不明显,而治疗后的分泌低谷变得明显。抑郁研究组DST阳性率显著高于对照组(57%对20%,χ2=4.24,p=0.039)。无论治疗前后,抑郁研究组患者血浆皮质醇水平与HAMD量表总分及绝望感和自杀观念的因子分呈显著正相关,但是抑郁对照组中这些相关系数无统计学意义。抑郁研究组早晨8点的血浆皮质醇浓度在治疗前后均显著高于健康对照组,而抑郁对照组的这一浓度并不比健康对照组高。结论本研究结果与先前关于抑郁症与HPA轴功能关系的研究结果大致相同。尽管如此,有自杀行为与无自杀行为的抑郁症患者之间还是存在某些差异。这些差异提示可能存在特定的自杀相关的HPA轴功能紊乱。有必要在大样本研究中进一步验证这些差异,以期能够在只报告有过自杀观念的人群中鉴别出实际有过自杀行为的个体。     

67例抑郁障碍伴自杀行为的临床对照研究

探讨抑郁障碍患者发生自杀行为的相关因素与预测。方法对６７例有自杀行为和１０８例无自杀行为的抑郁障碍进行了临床对照分析。结果高文化程度和城镇居民抑郁障碍患者自杀行为发生率高。结论Ｈａｍｉｌｔｏｎ抑郁量表总分不能作为预测抑郁障碍自杀危险性的有效指标，而焦虑／躯体化与绝望感因子分对抑郁障碍自杀危险性的预测有一定价值。     

双相障碍患者伴发焦虑症状的药物治疗的研究进展

双相障碍患伴发焦虑症状十分常见，这已经引起精神科医生的高度重视。双相障碍患伴发焦虑症状通常与下列因素相关：（1）发病年龄早，抑郁发作次数多，症状严重，出现自杀行为；（2）高致残率和隐匿型抑郁；（3）精力和体力的明显下降；（4）物质滥用以及进食障碍。因此，伴发焦虑症状的双相障碍患通常在急性期和维持治疗阶段疗效欠佳，且预后不良。另外，伴发惊恐障碍和广泛性焦虑的患对锂盐或抗惊厥药物的疗效欠佳。近期，有的学提出一种假设，即双相障碍患伴发惊恐障碍和／或广泛性焦虑，或伴发社交焦虑障碍，可能是双相障碍的一种特殊类型。对于双相障碍与焦虑障碍共病患，药物治疗的目的应该是要致力于使二种精神障碍都得以缓解，而不是在治疗一种精神障碍的同时造成另一种精神障碍病情恶化，这也是目前临床治疗上的一个挑战。     

社会支持对重性抑郁障碍患者自杀意念的影响

目的探讨社会支持对重性抑郁障碍(MDD)患者自杀意念的影响,为临床降低其自杀意念、减少自杀行为的发生提供参考。方法采用二阶段调查法,以在武汉市精神卫生中心门诊就诊的、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的1135例MDD患者为研究对象。采用患者健康问卷抑郁量表(PHQ-9)、社会支持评定量表(SSRS)进行调查,采用二元Logistic回归分析探讨MDD患者自杀意念的影响因素。结果1135例MDD患者中,有688例(60.62%)存在自杀意念,有自杀意念者PHQ-9评分高于无自杀意念者,差异有统计学意义[(14.18±5.02)分vs.(11.07±4.61)分,t=10.497,P<0.01]。有自杀意念者的主观支持、对支持的利用度及SSRS总评分均低于无自杀意念者,差异均有统计学意义(P均<0.01)。以自杀意念为因变量,以客观支持、主观支持、对支持利用度及PHQ-9评分为自变量的二元Logistic回归模型为logit(P)=-0.286+0.026X1-0.035X2-0.063X3+0.128X4,其中主观支持和抑郁均对自杀意念有预测作用(B=-0.035、0.128,P<0.05或0.01)。结论存在抑郁症状及缺乏社会支持(尤其是主观支持)可能是MDD患者出现自杀意念的危险因素。     

危机干预与自杀预防（二）抑郁,绝望及自杀行为（综述）

危机干预与自杀预防（二）抑郁、绝望及自杀行为（综述）童慧琦徐俊冕一、抑郁与自杀行为１９７１年美国国立卫生研究所自杀预防中心分类及命名委员会将自杀行为分为三类：①自杀意念（ｓｕｉｃｉｄａｌｉｄｅａｔｉｏｎ）：指从死亡是自愿，到即刻想杀自己的一系列想法；...     

不同年龄抑郁障碍患者电休克治疗疗效及影响因素分析

目的 对比青少年与成人抑郁障碍患者通过电休克治疗疗效,探究影响电休克治疗的相关因素。方法 入组2019年8月～2022年1月我院符合入组标准的青少年抑郁障碍患者19例和成人组抑郁障碍患者28例。两组患者均通过电休克治疗,分别在首次治疗前和末次治疗结束后24h用汉密尔顿抑郁量表（HAMD）、贝克自杀意念量表（BSI）对治疗效果做评定。结果 青少年组患者女性更多、伴精神病性症状更常见、年龄更小、起病更早、抑郁发作病程更长、精神心理科住院次数更少,差异具有统计学意义（P均<0.05）。两组患者治疗后HAMD、BSI评分均显著降低（P均<0.05）。两组患者治疗后量表评分减分率差异均无统计学意义（P均> 0.05）。无非自杀性自伤行为（OR=9.500,95%CI:1.091-82.725）、男性（OR=7.467,95%CI:1.799-30.994）与电休克治疗疗效有关。结论 青少年抑郁障碍患者和成人抑郁障碍患者通过电休克治疗均能有效改善临床症状及自杀风险,无非自杀性自伤行为和男性是电休克治疗疗效的影响因素。     

症状性发作性意识障碍误诊为癫痫3例报告

发作性意识障碍是痫性发作的常见重要症状，是诊断癫痫的重要病史证据之一，但不是必备条件。若病史了解不详细及相关检查不全面，临床有时会将其它疾病所致的发作性意识障碍误诊为癫痫，可造成患者接受错误治疗，有时甚至危及生命。现报道3例误诊病例。     

Body dysmorphic disorder and social phobia: cross-sectional and prospective data

Much attention has been paid to the relationship between body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD). However, to our knowledge, no published study has focused directly on the relationship between BDD and social phobia (SP). This is striking given similar clinical features of the two disorders, data showing elevated comorbidity between them, and Eastern conceptualizations of BDD as a form of SP. In this study, 39.3% of 178 individuals with current BDD had comorbid lifetime SP, and 34.3% had current SP. SP onset was typically before BDD. Individuals with BDD, with and without lifetime SP, were similar on many general characteristics (e.g., age of BDD onset, gender distribution, BDD severity, overall functional disability). However, subjects with BDD+SP were significantly less likely to be employed, were more likely to report lifetime suicidal ideation, and had poorer global social adjustment on one of two measures. Both BDD and SP were associated with elevated social anxiety; subjects with BDD+SP experienced additional social anxiety that appeared independent of BDD symptoms. Examining 1-year prospective data available for 161 subjects, BDD+SP subjects were somewhat less likely to experience remission (partial or full) of their BDD symptoms over 1-year follow-up, although this difference was not statistically significant (hazard ratio = .64, P = .18). In summary, these findings, including elevated rates of SP in patients with BDD, highlight a need for additional research on the relationship between BDD and SP.     

Associations in the longitudinal course of body dysmorphic disorder with major depression, obsessive-compulsive disorder, and social phobia

Body dysmorphic disorder (BDD) is an impairing and relatively common disorder that has high comorbidity with certain Axis I disorders. However, the longitudinal associations between BDD and comorbid disorders have not previously been examined. Such information may shed light on the nature of BDD's relationship to putative "near-neighbor" disorders, such as major depression, obsessive-compulsive disorder (OCD), and social phobia. This study examined time-varying associations between BDD and these comorbid disorders in 161 participants over 1-3 years of follow-up in the first prospective longitudinal study of the course of BDD. We found that BDD had significant longitudinal associations with major depression--that is, change in the status of BDD and major depression was closely linked in time, with improvement in major depression predicting BDD remission, and, conversely, improvement in BDD predicting depression remission. We also found that improvement in OCD predicted BDD remission, but that BDD improvement did not predict OCD remission. No significant longitudinal associations were found for BDD and social phobia (although the results for analyses of OCD and social phobia were less numerically stable). These findings suggest (but do not prove) that BDD may be etiologically linked to major depression and OCD, i.e., that BDD may be a member of both the putative OCD spectrum and the affective spectrum. However, BDD does not appear to simply be a symptom of these comorbid disorders, as BDD symptoms persisted in a sizable proportion of subjects who remitted from these comorbid disorders. Additional studies are needed to elucidate the nature of BDD's relationship to commonly co-occurring disorders, as this issue has important theoretical and clinical implications.     

Delusional versus nondelusional body dysmorphic disorder: clinical features and course of illness

DSM-IV's classification of body dysmorphic disorder (BDD) is controversial. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder. However, the relationship between these BDD variants has received little investigation. In this study, we compared BDD's delusional and nondelusional variants in 191 subjects using reliable and valid measures that assessed a variety of domains. Subjects with delusional BDD were similar to those with nondelusional BDD in terms of most variables, including most demographic features, BDD characteristics, most measures of functional impairment and quality of life, comorbidity, and family history. Delusional and nondelusional subjects also had a similar probability of remitting from BDD over 1 year of prospective follow-up. However, delusional subjects had significantly lower educational attainment, were more likely to have attempted suicide, had poorer social functioning on several measures, were more likely to have drug abuse or dependence, were less likely to currently be receiving mental health treatment, and had more severe BDD symptoms. However, when controlling for BDD symptom severity, the two groups differed only in terms of educational attainment. These findings indicate that BDD's delusional and nondelusional forms have many more similarities than differences, although on several measures delusional subjects evidenced greater morbidity, which appeared accounted for by their more severe BDD symptoms. Thus, these findings offer some support for the hypothesis that these two BDD variants may constitute the same disorder. Additional studies are needed to examine this issue, which may have relevance for other disorders with both delusional and nondelusional variants in DSM.     

Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University

The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002-2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = -9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (chi(2) = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5-4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults.     

Combined PTSD and depressive symptoms interact with post-deployment social support to predict suicidal ideation in Operation Enduring Freedom and Operation Iraqi Freedom veterans

Rates of suicide are alarmingly high in military and veteran samples. Suicide rates are particularly elevated among those with post-traumatic stress disorder (PTSD) and depression, which share overlapping symptoms and frequently co-occur. Identifying and confirming factors that reduce, suicide risk among veterans with PTSD and depression is imperative. The proposed study evaluated, whether post-deployment social support moderated the influence of PTSD–depression symptoms on, suicidal ideation among Veterans returning from Iraq and Afghanistan using state of the art clinical, diagnostic interviews and self-report measures. Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans (n=145) were invited to, participate in a study evaluating returning Veterans? experiences. As predicted, PTSD–depression, symptoms had almost no effect on suicidal ideation (SI) when post-deployment social support was high; however, when, post-deployment social support was low, PTSD–depression symptoms were positively associated with, SI. Thus, social support may be an important factor for clinicians to assess in the context of PTSD and, depressive symptoms. Future research is needed to prospectively examine the inter-relationship, between PTSD/depression and social support on suicidal risk, as well as whether interventions to, improve social support result in decreased suicidality.     

Tanning in Body Dysmorphic Disorder

Tanning in body dysmorphic disorder (BDD) has not previously been studied. In this study, 200 subjects with BDD were evaluated with measures to examine the prevalence of BDD-related tanning—i.e., darkening one's skin color by direct exposure to sunlight or artificial light which is motivated by a desire to improve a perceived appearance defect (i.e., a BDD concern). We also examined clinical characteristics of individuals who engaged in BDD-related tanning. 25% (95% CI, 19.0%–31.0%) of subjects reported BDD-related tanning. Among tanners, the skin was the most common body area of concern (84.0%). All tanners experienced functional impairment due to BDD, 26% had attempted suicide, and quality of life was markedly poor. 52% of tanners had received dermatologic treatment, which was usually ineffective for BDD symptoms. Tanners were more likely than non-tanners to compulsively pick their skin. In conclusion, tanning—a behavior with well-known health risks—is a relatively frequent BDD-related behavior.     

Depression,Anxiety, Anger,and Somatic Symptoms in Patients with Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a relatively common and impairing disorder. However, little is known about non-BDD symptoms and well-being in patients with this disorder. Seventy-five outpatients with DSM-IV BDD completed the Symptom Questionnaire, a validated self-report measure with four scales: depression, anxiety, somatic/somatization, and anger-hostility. Scores were compared to published norms for normal subjects and psychiatric outpatients. Participants in an open-label fluvoxamine trial completed the Symptom Questionnaire at baseline and endpoint. Compared to normal controls, BDD subjects had markedly elevated scores on all four scales, indicating severe distress and psychopathology. Compared to psychiatric patients, BDD subjects had higher scores on the depression, anxiety, and anger/hostility scales but not on the somatic/somatization scale. Scores on all scales significantly decreased with fluvoxamine. In conclusion, patients with BDD have markedly high levels of distress, are highly symptomatic, and have poor well-being in the domains of depression, anxiety, somatic symptoms, and anger-hostility. All of these symptoms significantly improved with fluvoxamine.     

Social Functioning in Body Dysmorphic Disorder: Assessment Considerations

Individuals with body dysmorphic disorder (BDD) have markedly poor social functioning; however, previous reports may underestimate impairment. Scoring on certain functioning measures such as the Social Adjustment Scale-Self Report (SAS-SR) potentially excludes more severely ill individuals from some domains, thereby possibly underestimating functional impairment. To explore this issue, 73 individuals with BDD who reported having no primary relationship (and were therefore excluded from scoring on the SAS-SR Primary Relationship domain) were compared to 58 individuals with BDD who had a primary relationship. Subjects without a primary relationship had significantly poorer global social adjustment on several measures. They also had poorer scores on the Global Assessment of Functioning Scale and greater severity of BDD and depressive symptoms at a trend level. These findings suggest that the SAS-SR may underestimate social impairment. This underestimation may pertain to other domains of functioning, other disorders, and certain other functioning and quality of life measures.     

Body Dysmorphic Disorder and Depression: Theoretical Considerations and Treatment Strategies

Body dysmorphic disorder (BDD), also known as dysmorphophobia, consists of a distressing and impairing preoccupation with an imagined or slight defect in appearance. BDD is an underrecognized and relatively common disorder that is associated with high rates of occupational and social impairment, hospitalization, and suicide attempts. BDD is unlikely to simply be a symptom of depression, although it often coexists with depression and may be related to depression. It is important to recognize BDD in depressed patients, because missing the diagnosis can result in refractory BDD and depressive symptoms. Available data indicate that BDD may not respond to all treatments for depression and may instead respond preferentially to serotonin-reuptake inhibitors. In addition, lengthier treatment trials than those required for depression may be needed to successfully treat BDD and comorbid depression. It can be difficult and challenging to diagnose BDD in depressed patients because the symptoms are often concealed due to embarrassment and shame. This paper discusses the relationship between BDD and depression and discusses practical strategies for recognizing and treating BDD and depressive symptoms in patients with depression.     

Depressed Suicide Attempters with Posttraumatic Stress Disorder

Posttraumatic stress disorder and major depressive disorder are well-established risk factors for suicidal behavior. This study compared depressed suicide attempters with and without comorbid posttraumatic stress disorder with respect to additional diagnoses, global functioning, depressive symptoms, substance abuse, history of traumatic exposure, and suicidal behavior. Adult patients consecutively admitted to a general hospital after a suicide attempt were interviewed and assessed for DSM-IV diagnosis and clinical correlates. Sixty-four patients (71%) were diagnosed with depression; of them, 21 patients (32%) had posttraumatic stress disorder. There were no group differences in social adjustment, depressive symptoms, or suicidal intent. However, the group with comorbid depression and posttraumatic stress disorder had more additional Axis I diagnoses, a higher degree of childhood trauma exposure, and more often reported previous suicide attempts, non-suicidal self-harm, and vengeful suicidal motives. These findings underline the clinical importance of diagnosis and treatment of posttraumatic stress disorder in suicide attempters.