利培酮治疗双相情感性精神障碍躁狂发作

1 理由和背景 1.1 不论国内还是国外,一般都是采用情感稳定剂加抗精神病药物作为治疗方案,这样既可以比较快速地控制躁狂,同时还有预防复发、防止转相的作用。这种约定俗成的方法为在情感性疾病中为使用利培酮这种非典型抗精神病药物提供了基础。 1.2 典型抗精神病药物在精神分裂症的治疗中容易导致EPS、TD以及其他副作用,而这引些副作用同样也可以在情感性疾病中出现,为了避免这些副作用,应用非典型抗精神病药物就可以避免这些副反应。     

缓解期双相障碍患者认知功能损害影响因素分析

目的:探讨缓解期双相障碍(BPD)患者认知功能损害的影响因素。方法:采用8个神经心理测验(共17项)对缓解期BPD50例和正常对照组50例进行注意力、言语学习和记忆、视觉记忆和执行功能的评定,并对上述神经心理测验结果和临床变量的关系进行相关分析。结果:即刻逻辑记忆、延迟逻辑记忆、威斯康星卡片分类测验(WCST)完成分类数、WCST持续性错误数、WCST非持续性错误数、完成第一分类应答数、连线测验-A、连线测验-B均与病程、住院次数、躁狂发作次数、抑郁发作次数呈显著性相关(P<0.05或P<0.01),数字广度测验-倒背和住院次数呈负相关(P<0.05)。结论:病程越长、住院次数和发作次数越多,缓解期BPD患者认知功能测验成绩越差。     

双相情感性精神障碍的药物治疗

双相情感性精神障碍的药物治疗于建新双相情感性精神障碍的有效治疗有赖于正确的诊断，必须弄清其临床横断面，纵向病程及躯体状况。临床横断面包括精神病特征，认知损害，自杀及对人或财产的危险，不适当的性行为，药物依赖，个人自理能力，家庭及朋友的支持，经济来源等...     

双相情感性精神障碍心理社会结局研究进展

Kraepelin[1] 描述躁狂—抑郁性精神病结局较好 ,但后来较多研究[2～ 4 ] 证实部分双相情感性精神障碍 (bipolardisorder简称BD)患者结局较差。本文拟对BD患者发作间期的心理社会结局及其相关因素作一回顾。1　结局的确定方法在对BD患者心理社会结局的研究中 ,其结局的确定采用多种方法 :(1)死亡率 ;(2 )疾病缓解期或循环期的长短 ;(3)对治疗的反应 ;(4 )缓解期所能达到的功能水平[5] 。2　BD发作间期的心理社会结局多数对BD结局的研究发现 ,有相当部分的患者社会功能受损。Poort报告 1/ 3的躁狂—抑郁性精神病患者或多或少由于其情感…     

双相情感性精神障碍患者应用抗抑郁药治疗的不良后果

双相情感性精神障碍的疾病期表现为躁狂相和抑郁相。最近的前瞻性研究表明，抑郁给大多数患者造成的问题比躁狂更为突出。双相Ⅰ型患者一生中有明显抑郁症状的累计时间平均超过30％，而躁狂症状累计时间少于10％。此外，未经治疗的双相情感性精神障碍患者的自杀率为20％，而绝大部分自杀企图发生在抑郁发作期间心。然而，对于双相情感性精神障碍抑郁相的有效治疗尚不尽如人意。     

奥氮平在双相情感性精神障碍躁狂发作中的应用

目前关于双相情感性精神障碍躁狂发作的治疗,不论国内还是国外,一般都是采用情感稳定剂加抗精神病药物作为治疗方案,这样既可以比较快速地控制躁狂,同时还有预防复发、防止转相的作用。但是典型抗精神病药物在精神分裂症的治疗中容易导致EPS、TD以及其他副作用,而这些副作用同样也可以在情感性疾病中出现,应用非典型抗精神病药物可以避免这些副反应。氯氮平虽然是非典型抗精神病药物,其应用受到特殊的血液学     

情感性精神障碍患者认知功能障碍的对照研究

目的　探讨情感性精神障碍患者是否存在认知功能损害，比较各亚型患者认知功能损害的特征。方法　对120例（抑郁症组、双相抑郁组、躁狂组及双相躁狂组各30例）情感性精神障碍患者（以下简称患者组）使用汉密尔顿抑郁量表（17项）、YOUNG躁狂量表、临床疗效总评量表、威斯康星卡片分类测验（WCST）、韦氏智力量表、韦氏记忆量表及Halstead—Retain神经心理成套检查（HRB—RC）分别于治疗前和治疗第12周末评定及比较。对照组为30名正常人。结果　（1）各亚型患者组治疗前WCST操作的总测验次数、持续错误数、随机错误数、分类数、智商（IQ）值、记忆商（MQ）值，以及抑郁症组、双相抑郁组的正确数与对照组比较，差异均有统计学意义（P〈0．05或P〈0．01）。各亚型患者组治疗第12周末与对照组比较，WCST操作的总测验次数、持续错误数、随机错误数、分类数及MQ值的差异有统计学意义（P〈0．05或P〈0．01）。在各患者组中，WCST操作的总测验次数、随机错误数、分类数、IQ值和MQ值治疗前与治疗第12周末的差异均有统计学意义（P〈0．05或P〈0．01），而组间的差异无统计学意义（P〉0．05）。（2）治疗前与治疗第12周末比较，各患者组中的HRB—RC测验的连线乙、触摸总时间、范畴，抑郁症组中的连线甲，抑郁症组、双相抑郁组治疗前的敲击次数等，与对照组的差异均有统计学意义（P〈0．05或P〈0．01）。结论　部分情感性精神障碍患者存在认知功能损害，各亚型患者间的差异不明显。     

188例情感性精神障碍患者临床分析

目的：调查情感性精神障碍患者的诊断和治疗情况。方法：选取某日我院心理科住院的188例情感性精神障碍患者,分析其临床资料。结果：双相谱系障碍诊断率为12．8％,新型抗抑郁药应用比例96．3％,合并苯二氮革类药物比例达95．2％,情感稳定剂使用率＜5％。结论：医生对双相障碍识别率不高,对情感稳定剂的认识不够全面.     

双相情感性精神障碍伴发阴茎异常勃起1例报道

双相情感性精神障碍伴发阴茎异常勃起者在精神科临床中极为罕见,现报道1例如下: 临床资料 住院号20054,男,27岁。已婚,工人。自9岁起即养成手淫的不良习惯。因情绪低落与高涨交替发作11年,先后住院3次,于1995年6月29日因抑郁,失眠,少语,少动3周第4次入我院治疗。入院查体未见明显异常。精神检查:意识清,接触较被动,思维联想缓慢,     

锂盐以外的药物治疗双相情感性精神障碍的研究进展

锂盐以外的药物治疗双相情感性精神障碍的研究进展袁浩龙治疗双相情感性精神障碍病人的主要目的是控制急性抑郁和躁狂发作，以及预防将来的再发。希望有一种有效的心境稳定（ｍｏｏｄｓｔａ－ｂｉｌｉｚｉｎｇ）药来达到这些目的。理盐作为最初用于双相病人的治疗，其有效...     

Electrophysiological and cognitive function in young euthymic patients with bipolar affective disorder

Objectives: EEG abnormalities and neurocognitive deficits have been reported in patients with bipolar affective disorder. The aim of this study was to ascertain whether brain function remains impaired in young bipolar patients who have become euthymic in response to treatment. Methods: Brain function was assessed by quantitative electroencephalographic (EEG) power-spectral mapping and by a battery of neuropsychological tests. The subjects were 29 euthymic bipolar patients aged 18–40 years and 26 healthy volunteers of similar age, IQ and socioeconomic status. Results: Grand means of spectral power of the resting EEG showed significantly (from p<0.01 to p<0.0001) greater power in all wave bands (delta, theta, alpha and beta) in patients compared with controls. The most marked increases were in right temporal theta and left occipital beta power (with eyes open) encompassing brain areas concerned in visuospatial processing. Neurocognitive performance was significantly impaired in the patients compared with controls in a range of visuospatial tasks. Conclusions: The findings show significant disturbance of EEG activity and deficits in visuospatial processing in young bipolar patients despite clinical euthymia. The abnormalities were not related to age of onset or duration of illness and do not appear to be attributable to medication. The cognitive impairments were associated with the number of previous affective episodes.     

Cognitive functions in bipolar affective disorder and schizophrenia: comparison

Aims: Earlier comparisons of cognitive impairment among patients with bipolar disorder and schizophrenia have found a largely similar profile of deficits, but results have varied between studies. This prompted the current attempt at another such comparison. Methods: Executive functions, memory, IQ, attention–concentration and perceptuomotor function were assessed in 48 bipolar disorder patients with operationally defined euthymia, and compared with 32 schizophrenia patients in remission, and 23 normal controls. Comparisons were re‐attempted after controlling for years of schooling and residual affective symptoms. Results: Uncontrolled comparisons indicated that, compared to controls, both bipolar disorder and schizophrenia patients were significantly impaired on different tests of executive function, memory, IQ and perceptuomotor functions. Controlling for years of schooling and residual affective symptoms, however, served to remove most of the differences between patients and controls, apart from some aspects of executive function in schizophrenia and memory impairment in both schizophrenia and bipolar disorder. Patients with schizophrenia consistently performed worse than patients with bipolar disorder, but none of the differences between schizophrenia and bipolar disorder were significant. Conclusions: Patients with bipolar disorder exhibit cognitive difficulties that are very similar to schizophrenia in terms of their profile, although patients with schizophrenia may have more severe and widespread impairments. The resemblance in cognitive profiles has important implications for the etiology and treatment of both disorders.     

Neuroleptic-induced supersensitivity psychosis in patients with bipolar affective disorder

Clinical syndromes thought to arise from neuroleptic-induced dopamine receptor supersensitivity are well described in psychiatry. Tardive dyskinesia may arise from neostriatal supersensitivity and supersensitivity psychosis may arise from mesolimbic supersensitivity in schizophrenics chronically treated with neuroleptics. The authors present 5 cases of supersensitivity psychosis that developed in patients with bipolar affective disorder. The clinical syndrome is described and the implications for the long-term course of bipolar affective disorder are discussed.     

Cognitive impairment in later life in patients with early-onset bipolar disorder

OBJECTIVES: Cognitive impairment may interfere with psychosocial functioning in bipolar disorder (BD). There is limited information regarding the cognitive function of elderly bipolar patients with onset at a young age. The present study aimed to investigate the frequency and the determinants of cognitive impairment in elderly early-onset bipolar patients. METHODS: Using the Clock-drawing Test (CDT), the Mini Mental State Examination (MMSE), and the Cognitive Abilities Screening Instrument (CASI), we examined euthymic patients with bipolar I disorder in Taiwan, aged 60 years and older. Clinical data were obtained by reviewing medical records and personal interviews with patients and their family members. The onset of BD prior to the age of 40 years is defined as 'early-onset'. RESULTS: Of the 52 early-onset patients, 42.3% were determined to have cognitive impairment by exhibiting either abnormal CDT or education-adjusted MMSE scores. In a multiple regression model, years of education and the age at the last manic/hypomanic (but not depressive) episode accounted for the greatest variance in both MMSE and CASI scores. While educational level and the age at the last manic/hypomanic episode were not considered in the regression model, onset with depressive syndrome and current age explained 21.5% of the variance in MMSE scores. Age at the first depressive episode, the first manic episode before the age of 40 years, and comorbid diabetes accounted for 16.7% of the variance in CASI scores. CONCLUSIONS: There appeared to be a sizable proportion of elderly early-onset bipolar patients having cognitive impairment. It is suggested that clinical manifestation of first-onset affective episode and impact of medical comorbidity affect the cognition of early-onset BD in later life.     

Comorbidity of anxiety disorders in patients with remitted bipolar disorder

Comorbidity between bipolar disorder and anxiety disorders has attracted considerable attention in recent years. However, a majority of the earlier studies examined anxiety disorders in acutely ill patients resulting in a possible confounding effect of the affective episodes. This study examines the prevalence of anxiety disorders in remitted bipolar subjects recruited from a psychiatric hospital in India and their effect on the severity of bipolar illness. A total of eighty remitted DSM-IV adult bipolar subjects and 50 non-psychiatric controls were recruited over a 10-month period. They were evaluated using a structured interview and various scales. The effect of anxiety disorders on bipolar severity was analyzed using multiple regression analyses. Anxiety disorders were highly prevalent in bipolar subjects compared to controls (49 [61%] vs. 7 [14%], χ² = 28.01, P < 0.001). Commonest lifetime anxiety disorder was obsessive-compulsive disorder (35%). Lifetime anxiety disorder had significant effect on all four indices of severity of illness, that included (1) percentage of time spent in episodes (Beta = 18.67, SE = 5.11, P < 0.001), (2) maximum period of continuous euthymia in the preceding 2 years (Beta = −5.26, SE = 1.71, P = 0.003), (3) presence of psychosis (Beta = 3.22, SE = 1.02, P = 0.002), and 4) response to mood stabilizers (Beta = −2.11, SE = 0.76, P = 0.006). The findings of this study confirm previous observations of the high prevalence and negative impact of comorbid anxiety disorders in bipolar disorder and also demonstrate that the findings are similar in culturally diverse settings. Future studies should systematically examine the various treatment options for anxiety disorders in bipolar patients. It is also necessary to examine the neurobiological and family/genetic correlates of anxious bipolar subjects to validate if they are a subgroup of bipolar disorders.     

Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder

Objectives: To highlight and discuss thyrotoxicosis after lithium withdrawal as a potential complication of lithium therapy for bipolar disorder.
Case Reports: Both patients presented developed thyrotoxicosis, the first patient after stopping the lithium completely, and the second patient after a reduction in the lithium dose.
Conclusions: Clinicians should be alert to the possibility of thyrotoxicosis emerging when lithium is being completely or partially withdrawn. Such withdrawal could unmask a latent hyperthyroidism.     

Hashimoto's encephalopathy presenting with bipolar affective disorder

OBJECTIVE: We report on a rare case of Hashimoto's encephalopathy associated with a bipolar affective disorder. CASE REPORT: A 32-year-old woman presented with a bipolar affective disorder and Hashimoto's thyroiditis. Neurological investigations (magnetic resonance imaging of the brain and cerebrospinal fluid) did not reveal any pathological findings except for a pathological electroencephalogram (EEG). Despite consequent antidepressant treatment, the patient remitted only in conjunction with normalization of the EEG after short-term treatment with high doses of prednisolone. CONCLUSION: In treatment resistant courses of disorders, the thorough clinical and laboratory investigation of our patient revealed a very efficient treatment strategy. Cases of Hashimoto's encephalopathy associated with the occurrence of a manic episode and hence with bipolar disorder are rare; this is the first reported case. However, clinicians should be alert to this possibility.     

碳酸锂、丙戊酸钠及奎硫平对双相障碍患者认知功能的影响

目的:探讨碳酸锂,丙戊酸钠和奎硫平对双相障碍患者认知功能的影响。方法:110例稳定期双相障碍I型患者分成4组,分别是碳酸锂组26例,丙戊酸钠组24例,碳酸锂+奎硫平组27例和丙戊酸钠+奎硫平组33例。采用数字符号,连线测验,数字广度,视觉再生,言语流畅性测验,威斯康星卡片分类测验(WCST)和汉诺塔检测认知功能,比较组间认知功能的差异。结果:Spearman相关分析显示,病程与所有认知功能指标均无显著相关(P均>0.05)。方差分析显示,汉诺塔计划时间组间差异有统计学意义(F=3.5,P<0.05)。LSD检验表明,碳酸锂组的汉诺塔计划时间成绩分别比丙戊酸钠组,碳酸锂+奎硫平组和丙戊酸钠+奎硫平组差,差异有统计学意义(P<0.05)。结论:碳酸锂可能对稳定期双相障碍患者的某些执行功能有损害。