生活事件、社会支持与双相情感障碍患者症状复发的相关研究

目的探讨生活事件和社会支持与双相情感障碍患者症状复发的关系,为有针对性地实施干预提供依据。方法选取在中山市第三人民医院住院的符合《国际疾病分类(第10版)》(ICD-10)双相情感障碍诊断标准的70例患者为研究组,将研究组的健康家庭成员中与患者在性别、年龄、受教育程度等方面相近者作为对照组,共70人。采用生活事件量表(LES)和社会支持评定量表(SSRS)对两组人群进行测评。结果双相情感障碍患者与对照组人群的社会支持的情况差异有统计学意义(P0.05),这种差异主要体现在客观支持方面(P0.05),在主观性评价和对支持的利用度方面差异无统计学意义(P0.05)。生活事件对双相情感障碍患者的影响与对照组相比差异有统计学意义(P0.05)。经历负性生活事件,尤其是在家庭和工作方面发生的负性生活事件,对患者有明显的影响(P0.05)。回归分析显示患者症状复发的可能性与SSRS的客观支持评分呈负相关(OR=0.69)、与负性生活事件呈正相关(OR=1.05)。结论负性生活事件的影响程度和能够获得的客观社会支持程度是影响双相情感障碍患者症状复发的重要因素。     

A型行为与情感性障碍

目的 为研究A型行为与情感性障碍的关系。方法 采用A型行为问卷评估120例情感性障碍患者与120例健康人的行为类型,并比较单、双相情感性障碍患者的行为类型。结果情感性障碍患者中A型行为占62.7％,显著高于正常对照组(43.9％)。单、双相情感性障碍者在行为类型方面有明显差别,双相以A型行为为主,单相者以B型行为多见;并发现反复发作性躁狂症者的行为类型与双相情感性障碍者类似。结论 情感性障碍患者以A型行为多见。单相躁狂症与双相情感性障碍应为情感性障碍同一临床亚型。     

双相障碍患者家庭功能对照研究

目的:探讨双相障碍(BD)患者的家庭功能。方法:使用家庭亲密度与适应性问卷(FACES)及家庭功能问卷(FAD)对67例BD患者(BD组)及101名正常对照者(NC组)进行比较。结果:两组FACES评分差异无统计学意义;BD组FAD中情感卷入维度评分[(2.35±0.46)分]明显高于NC组[(2.20±0.42)分,P0.05]。结论:BD患者的家庭功能缺陷体现在情感卷入上。     

双相情感障碍复发的危险因素

目的 探讨双相情感障碍治疗后复发的危险因素.方法 研究对象为2017年4月～2019年4月120例双相情感障碍患者,经治疗达痊愈标准后随访1年,记录复发情况,设为复发组与未复发组,比较两组性别、睡眠障碍等临床资料,经单因素、多因素分析治疗后复发的危险因素.结果 120例患者复发28例,复发率23.33％,其中抑郁14例...     

甲状腺功能水平与双相情感障碍相关性的对照研究

目的 探索甲状腺功能与双相情感障碍的相关性.方法 以符合美国精神疾病分类与诊断标准第4版修订本(DSM-Ⅳ-TR)的双相情感障碍诊断标准的患者59例为研究对象,并选取41名健康人作为对照,应用酶联免疫吸附法(ELISA)分别测定所有研究对象的血清甲状腺激素水平,包括TT3、FT3、TT4、FT4及TSH.选用HAMD、HAMA及Bech-Rafaelsen躁狂量表评估患者组临床症状.结果 双相躁狂组中TT4、FT4水平明显高于对照组,FT3水平明显高于抑郁组,差异有统计学意义(P<0.01).双相抑郁组中TT3、FT3水平明显低于对照组,FT4水平则明显高于对照组,差异有统计学意义(P<0.01).按性别分层比较,女性双相躁狂组FT4水平与对照组相比明显升高,差异有统计学意义(P<0.05);女性双相抑郁组TT3明显低于对照组或双相躁狂组,FT4明显高于对照组,FT3则明显低于对照组,差异均有统计学意义(P<0.05),而男性躁狂组中仅TT4水平显著高于对照组(P<0.05).在双相抑郁患者中,HAMD总分与FT4呈负相关(r=-0.34,P=0.03).结论 双相情感障碍患者的甲状腺功能存在一定的改变,不同临床相甲状腺功能改变亦不相同,且这种变化以女性患者明显.     

精神分裂症和双相情感障碍住院患者家属的生活质量及社会支持状况

目的：探讨精神分裂症和双相情感障碍（躁狂发作或抑郁发作及混合发作）住院患者家属生活质量及社会支持状况。方法以精神分裂症和双相情感障碍住院患者的家属为研究对象,进行一般调查表（自制）、简明健康调查量表（SF－36）、社会支持评定量表（SSRS）等检测,并对结果进行统计分析。结果（1）精神分裂症和双相情感障碍住院患者家属生活质量的各项指标均低于全国平均水平,差异有统计学意义（P ＜0．01）。（2）精神分裂症和双相情感障碍住院患者家属社会支持总分与全国常模比较,差异无统计学意义（P ＞0．05）;患者家属文化程度越高,获得的社会支持情况越好,但差异无统计学意义（P ＞0．05）;双相情感障碍患者家人获得的社会支持状况好于精神分裂症患者家属,差异有统计学意义（ P＝0．049）。结论精神分裂症和双相情感障碍住院患者家属的生活质量令人担忧,这可能与疾病的特点有关。     

山东省双相情感障碍6号染色体基因扫描研究

目的 对双相情感障碍患者及正常对照者的6号染色体进行扫描,查找双相情感障碍的关联位点,进而定位易感基因.方法 在6号染色体上间隔10 cM(厘摩)遗传距离选择了20个微卫星遗传标记,对104例发病年龄≤20岁的双相情感障碍患者与1000例正常对照者组成的DNA混合样本分别进行了扫描.采用CLUMP软件进行统计学分析,逐一比较患者组与对照组等位基因频率的差异.结果 在D6S262位点发现患者组与对照组的等位基因频率差异有显著性意义(P<0.05).结论 山东省双相情感障碍患者与6号染色体上D6S262位点关联,基因突变或甲基化调控等致病因子可能位于其附近.     

单双相抑郁障碍患者应对方式的比较

目的 比较双相抑郁障碍与复发性抑郁障碍患者的应对方式,并评估应对方式与两种疾病的关联.方法 采用横断面的病例对照设计,共入组双相抑郁障碍患者144例,复发性抑郁障碍患者189例,健康对照123例,应用特质应对方式问卷(TCSQ)评估被试的应对方式.结果 与对照组比较,两患者组消极应对方式得分较高,积极应对方式得分较低,差异均有统计学意义(P<0.01);与复发抑郁障碍患者相比,双相抑郁障碍组积极应对方式较高(P<0.01).同种疾病中,非缓解期的患者较缓解期患者消极应对方式得分更高,积极应对方式得分更低.Logistic回归分析结果显示,在控制了年龄和疾病状态的影响后,积极应对方式仍是患双相障碍的危险因素(OR=1.064,95%CI=1.026~1.102),该模型对双相障碍的预测准确率为64.3%.结论 与复发抑郁障碍患者相比,双相抑郁障碍患者多采用较为积极的应对方式;采用较为积极的应对方式的抑郁障碍患者,发展成双相障碍的可能性较大.     

精神分裂症患者与躁狂发作患者父母教养方式对照研究

目的 探讨精神分裂症与双相情感障碍躁狂发作患者的父母教养方式特点.方法 采用父母教养方式评价量表(EMBU)对43例精神分裂症患者及38例双相情感障碍躁狂发作患者父母教养方式(研究组)进行评定,并与38例正常受试者(对照组)比较.结果 与双相情感障碍躁狂发作及正常被试比较,精神分裂症患者组在教养方式上,父母均表现为高惩罚与严厉、高过分干涉和高拒绝与否认(P＜0.05);双相情感障碍躁狂发作患者组教养方式各因子得分虽低于正常对照组,但差异无统计学意义(P＞0.05).结论 精神分裂症患者父母教养方式均存在多方面问题,可能对精神分裂症发病有一定影响.双相情感障碍躁狂发作患者的父母教养方式可能存在一定问题,需要进一步研究.     

去甲肾上腺素转运体、Gβ3 基因多态性与双相障碍Ⅱ型的关联分析

目的 通过去甲肾上腺素转运体(NET)相关第二信号转导通路部分中介分子的单核苷酸多态性(SNPs)与双相障碍关系的探讨,寻找双相障碍的生物学标记.方法 选择符合DSM-Ⅳ有关双相障碍-Ⅱ诊断标准、随访3年以上的患者152例(病例组),健康对照187名(对照组),采用连接酶检测反应(LDR)技术,测定NET基因的rs5569、rs2242446及Gβ3亚基基因的rs5433共3个SNPs进行检测,比较两组间3个SNPs的基因型及等位基因频度差异,采用最优尺度分析判断不同基因型与情感稳定剂疗效的关系.结果 病例组与对照组比较,3个位点的基因型及等位基因频度分布差异均无统计学意义(P>0.05);rs5433的TT型患者对情感稳定剂效果优于其他型,差异有统计学意义(P<0.05).结论 没有发现rs5569、rs2242446及rs5433与双相障碍的发病有关,但发现Gβ3基因多态性与情感稳定剂的预防复发效应有关,提示rs5433可能是使用情感稳定剂标志SNPs之一.     

The Maudsley Bipolar Disorder Project: the effect of medication,family history,and duration of illness on IQ and memory in bipolar I disorder

BACKGROUND: Despite the growing recognition of the importance of cognitive impairment in psychiatric disorders, the effect of clinical factors, such as medication use and family history of affective disorders, on cognition in bipolar I disorder patients still remains unclear. This study examines the contribution of known and potential predictors to both general intellectual function and memory in a representative population of bipolar I disorder patients. METHOD: Of the 425 patients receiving treatment within a defined catchment area, 63 were identified as having bipolar I disorder. Of these patients, 43 were enrolled in the study and participated in a personal interview by a psychiatrist. All patients were invited to participate in a personal interview by a psychiatrist, and information on family history, past psychiatric history, past and current treatments, duration of illness, and age at onset was collected, in addition to demographic data. Cognitive performance was assessed using the Wechsler Adult Intelligence Scale-Revised, the National Adult Reading Test, and the Wechsler Memory Test III. RESULTS: Forty-three patients with DSM-IV bipolar I disorder were enrolled into the Maudsley Bipolar Disorder Project. Patients on treatment with antipsychotic drugs had a lower current full scale IQ, lower general memory scores, and lower working memory scores. A family history of affective disorders was associated with a higher full scale IQ, but not with either general or working memory measures. Duration of illness was negatively associated with general memory scores, but had no effect on either IQ or working memory measures. CONCLUSION: Current antipsychotic medication, duration of illness, and family history of affective disorder were the most significant predictors of IQ and memory function in bipolar I disorder patients.     

Clinical characteristics of bipolar I patients according to their family history of affective disorders

BACKGROUND: The familial nature of bipolar disorder has been well described and multiple genes are probably involved in most or all cases. Each gene contributes equally to a bipolar phenotype and it may contribute to clinical characteristics. However, the genetic transmission of bipolar disorder remained undetermined up to now, partly due to clinical and genetically heterogeneity. In Tunisia, genetic study will profit from specific interests and advantages: the high rates of consanguinity, the existence of large families, and the relative geographical stability of the population. OBJECTIVE: The aim of this study was to compare clinical characteristics of familial and nonfamilial bipolar I disorder. METHOD: One hundred and thirty subjects met DSM-IV criteria for a bipolar I disorder; they were recruited and divided into groups according to their family history of affective disorders. Group 1 with a familial history group, comporting bipolar I patients with a family history of affective disorders in first and second degree relatives (n = 76; 52 males and 24 females, mean age = 37.2 +/- 10.7 years) was compared to group 2 (nonfamilial history group), comporting bipolar I patients without a family history of affective disorders (n = 54; 29 males and 25 females, mean age = 38.1 +/- 10.9 years). Available information was obtained from a structured clinical interview, collateral history, and medical records. The family investigation permitted completion of genealogies over three generations. The comparison of the two groups was based on the clinical characteristics (age at onset, numbers of affective episodes, nature and severity of the last affective episode,...). RESULTS: There were no significant differences between the two groups concerning demographic and social features, with the exception of professional activity. Indeed 30.2% of patients with a family history of affective disorders were unemployed versus 12.9% of patients without a family history of affective disorders (p = 0.02). Bipolar I patients with a family history of affective disorders were characterised by an early age at onset of the first episode (before 20 years) (48.7 versus 24.0%; p = 0.004), a high frequency of affective episodes (8.1 +/- 3.6 versus 6.0 +/- 3.5; p = 0.002) and had been more often hospitalised than patients without a family history of affective disorders (5.7 +/- 3.0 versus 4.7 +/- 3.0; p = 0.06). No significant differences were found concerning the nature of the first affective episode in bipolar I patients with or without a family history of affective disorders. Eleven women had developed their first affective episode during the puerperal period; eight of whom had a family history of affective disorders (p = 0.07). The last affective episode was significantly more severe (94.8 versus 77.8%; p = 0.003) and more often associated with psychotic features (55.3 versus 35.2%; p = 0.02) in patients with a family history of affective disorders. After multiple regression, the high frequency of affective episodes and the severity of last episode were more related with a family history of affective disorders. CONCLUSION: The results of our study provide evidence of familiality for some clinical characteristics which can be useful as phenotypic measures in future molecular genetic studies.     

Cognitive endophenotypes in a family with bipolar disorder with a risk locus on chromosome 4

Objectives: We studied cognitive function in high‐risk relatives belonging to a single extended family showing linkage of bipolar disorder to a locus on chromosome 4. High‐risk relatives were defined as those that carried the risk haplotype of polymorphic markers, identified in a previous linkage study. This family provided a rare opportunity to characterize a neuropsychological endophenotype in a homogeneous sample of relatives with a common genetic risk factor. Methods: Fifteen family members carrying the risk haplotype (eight diagnosed with bipolar disorder or depression and seven with no psychiatric diagnosis), unrelated patients with bipolar disorder (n = 36) and major depressive disorder (n = 40), and healthy control subjects (n = 33) were administered the California Verbal Learning Test, Verbal Fluency Test, Hayling Sentence Completion Test, and Brixton Spatial Anticipation Test to assess verbal memory, verbal fluency, and executive function. Results: Compared with healthy controls, family members carrying the risk haplotype were impaired in indices of memory and executive function. There were no significant differences between unaffected and affected haplotype‐carrying family members in any cognitive measure. Pronounced deficits in the encoding stage of verbal memory and category verbal fluency were evident in individuals with the risk haplotype. Conclusions: Verbal learning and semantic verbal fluency impairments may represent a cognitive endophenotype for both bipolar disorder and major depression in relatives of bipolar disorder patients, as impairment was also present in high‐risk relatives who had not developed any affective disorder symptoms. These findings suggest that impairment in semantic organization may be linked to the genetic aetiology of bipolar disorder.     

情感性精神障碍不同亚型的预后比较

目的探讨情感性精神障碍亚型与预后的关系。方法对１１７例情感性精神障碍患者进行出院８年后的随访调查，并将其分为单相抑郁症（２５例）、双相非混合／快速循环型（６６例）和双相混合／快速循环型（２６例）３组。结果双相混合／快速循环型的复发、自杀和慢性化的发生率均高于其它两组，大体评定量表评分低于其它两组，社会功能缺陷筛选量表总分高于其它两组。结局评定显示，双相混合／快速循环型最差，双相非混合／快速循环型一般，单相抑郁症最好。结论提示双相混合／快速循环型是情感性精神障碍预后较差的临床类型     

双相情感性精神障碍患者迟发性运动障碍初探

调查３３例双相情感性精神障碍患者迟发性运动障碍（ＴＤ）有关的因素，并评估其认知功能。用迟发性运动障碍量表（Ｓｉｍｐｓｏｎ量表）、认知功能问卷调查，并收集临床资料。结果发现，有ＴＤ的比无ＴＤ的患者住院总次数多，因躁狂发作住院的次数多，抗精神病药治疗时间长，平均日剂量高，合并抗胆碱能药时间长。表明长期、高剂量抗精神病药治疗可能是双相情感性精神障碍病人ＴＤ产生的高危因素，且长期并用抗胆碱能药增加ＴＤ产生的危险。有无ＴＤ的病人认知功能并无差异。     

双相情感障碍混合发作血清细胞因子水平研究

目的：比较双相情感障碍混合发作与躁狂发作及抑郁发作患者之间血清细胞因子的水平。方法：采用酶联免疫吸附法测定38例双相情感障碍混合发作患者（混合组）、54例躁狂发作患者（躁狂组）、47例抑郁发作患者（抑郁组）及38名正常人（对照组）血清白介素-1（IL-1β）、白介素-2（IL-2）及白介素-6（IL-6）的浓度;混合组患者于治疗前和治疗8周进行Hamilton抑郁量表（HAMD-24）和Young躁狂量表（YMRS）评定。结果：混合组IL-1β浓度显著高于躁狂组及抑郁组（P〈0.01）,但与对照组差异无统计学意义（P〉0.05）。混合组IL-2浓度与躁狂组、抑郁组及对照组之间差异均无统计学意义（P〉0.05）。混合组IL-6浓度显著高于躁狂组、抑郁组及对照组（P〈0.001）。混合组IL-6浓度治疗8周后较治疗前显著下降（t=3.372,P〈0.01）,与对照组比较差异无统计学意义（t=1.823,P〉0.05）。混合组治疗前后IL-6浓度差值与HAMD-24、YMRS减分率之间均无显著相关（r分别=-0.211、-0.100,P均〉0.05）。结论：双相情感障碍混合发作可能存在IL-6诱导的免疫功能异常,有不同于双相情感障碍躁狂发作及抑郁发作的生物学特征。     

伴精神病性症状情感性精神障碍的随访观察

目的　探讨伴精神病性症状的情感性精神障碍（ Ｐ Ａ Ｄ） 的预后。方法　对６５ 例 Ｐ Ａ Ｄ 及６９ 例不伴精神病性症状的情感性精神障碍（ Ｎ Ｐ Ａ Ｄ） 进行３ ～６ 年随访,调查其再入院及转归情况。并比较其在人口学特征、疾病表现等方面的异同。结果　４６ ．６７ ％的躁狂症,４４ ％ 的抑郁症及５２ ．１７ ％ 的双相情感障碍都伴发精神病性症状。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在人口统计学,疾病对目前生活、工作的影响等方面无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症,它们有如下特征：起病年龄较小,平均住院日较长,再入院次数较多,伴与情感不一致的妄想症状较多。结论　 Ｐ Ａ Ｄ 是一种常见疾病。 Ｐ Ａ Ｄ 与 Ｎ Ｐ Ａ Ｄ 在预后上无显著差异。有１８ ．９ ％ 的 Ｐ Ａ Ｄ 再入院诊断改变为精神分裂症。     

Differences between patients with borderline personality disorder who do and do not have a family history of bipolar disorder

Diagnostic confusion sometimes exists between bipolar disorder and borderline personality disorder (BPD). To improve the recognition of bipolar disorder researchers have identified nondiagnostic factors that point toward bipolar disorder. One such factor is the presence of a family history of bipolar disorder. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the demographic, clinical, and psychosocial characteristics of patients with BPD who did and did not have a family history of bipolar disorder. A large sample of psychiatric outpatients were interviewed with semi-structured interviews. Three hundred seventeen patients without bipolar disorder were diagnosed with DSM-IV borderline personality disorder. Slightly less than 10% of the 317 patients with BPD (9.5%, n = 30) reported a family history of bipolar disorder in their first-degree relatives. There were no differences between groups in any specific Axis I or Axis II disorder. The patients with a positive family history were significantly less likely to report excessive or inappropriate anger, but there was no difference in the frequency of other criteria for BPD such as affective instability, impulsivity, or suicidal behavior. The patients with a positive family history reported a significantly higher rate of increased appetite and fatigue. There was no difference in overall severity of depression, scores on the Global Assessment of Functioning, history of psychiatric hospitalizations, suicide attempts, time unemployed due to psychiatric reasons during the 5 years before the evaluation, and ratings of current and adolescent social functioning. There was no difference on any of the 5 subscales of the childhood trauma questionnaire. Overall, we found few differences between BPD patients with and without a family history of bipolar disorder thereby suggesting that a positive family history of bipolar disorder was not a useful marker for occult bipolar disorder in these patients.