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。     

残留症状对缓解期双相情感障碍患者心理社会功能的影响

目的探讨残留症状对缓解期双相情感障碍患者心理社会功能的影响。方法采用横断面研究,选取2019年11月至2020年12月就诊于河北医科大学第一医院门诊的81例纳入符合ICD-10诊断的缓解期双相情感障碍患者,对其进行人口统计学调查,采用24项汉密尔顿抑郁量表(HAMD)、轻躁狂量表(HCL-32)、汉密尔顿焦虑量表(HAMA)测量双相情感障碍患者的残留情绪症状,采用霍普金斯词汇学习测验-修订版(HVLT-R)、简易视觉空间记忆测验-修订版(BVMT-R)、连线测试A(TMT-A)部分实验、数字广度测试评估残留的认知症状,使用功能大体评定量表(GAF)评估心理社会功能。根据功能大体评定量表评分将患者分为GAF=9组(27例)和GAF<9组(54例)。采用SPSS 22.0统计软件对数据进行分析。结果GAF<9组的女性[40.7%(22/54)]明显多于GAF=9组[33.3%(9/27)],受教育年限[12.00(9.00,13.00)年]明显少于GAF<9组[16.00(12.00,16.00)年],无职业者[40.7%(22/54)]明显多于GAF=9组[18.5%(5/27)],抗精神病药物使用剂量[(10.48±5.40)mg]明显高于GAF=9组[(7.99±5.65)mg],HAMD评分[6.00(3.75,10.00)分]明显高于GAF=9组[3.00(0,6.00)分],BVMT-RT1评分[4.00(1.00,8.00)分]明显低于GAF=9组[6.00(3.00,10.00)分],BVMT-RDR评分[7.50(3.00,11.25)分]明显低于GAF=9组[11.00(8.00,12.00)分],DST评分[14.00(12.00,16.00)分]低于GAF=9组[15.00(13.00,18.00)分]。两组患者的性别、受教育年限、婚姻、职业、吸烟、饮酒、既往史、心境稳定剂、抗抑郁药、苯二氮䓬类药物的使用、HAMD评分、DST评分、BVMT-RT1评分、BVMT-RDR评分比较,差异均有统计学意义(P<0.05)。双相情感障碍患者缓解期的整体功能与受教育年限(r=-0.34,95%CI:-0.53~-0.12,P<0.01)、HAMD评分(r=0.37,95%CI:0.16~0.56,P<0.01)、BVMT-RT1评分(r=-0.23,95%CI:-0.41~-0.02,P=0.04)、BVMT-RDR评分(r=-0.24,95%CI:-0.45~-0.02,P=0.03)、数字广度测验总分(r=-0.23,95%CI:-0.42~-0.01,P=0.04)、抗精神病药物(r=0.23,95%CI:0.02~0.44,P=0.04)之间存在显著的相关性。缓解期的双相情感障碍患者残留抑郁症状(χ^(2)=5.33,OR=1.58,95%CI:1.07~2.33,P=0.02)、使用抗精神药物(χ^(2)=4.77,OR=1.37,95%CI:1.03~1.82,P=0.03)是其心理社会功能损害的危险因素;受教育年限长是其保持良好心理社会功能的保护因素(χ^(2)=5.31,OR=0.34,95%CI:0.14~0.85,P=0.02)。结论缓解期双相情感障碍患者心理社会功能的损害危险因素包括残留抑郁症状、使用抗精神病药物,保护因素包括受教育年限长。     

精神分裂症和双相情感障碍的重叠

精神分裂症和双相情感障碍两种疾病在多方面存在共性,本文从疾病早期症状、遗传学、神经影像学、神经心理学几个方面作了综述。     

青少年首发双相情感障碍精神病性症状特点及对诊断的影响

目的：探讨青少年双相情感障碍患者首次发作时症状特点、精神病性症状的特征及诊断情况,为青少年双相情感障碍的及时诊断提供依据.方法本研究为回顾性研究,对2010年1月1日~2015年10月31日于第四军医大学西京医院心身科住院,年龄13~17岁,诊断为首次发作双相情感障碍的119例患者的临床特征及精神病性症状的特点进行总结分析.结果首次就诊误诊86例,占72.26％;其中,躁狂发作误诊14例,出现精神病性症状的为12例,误诊8例(66．67％);抑郁发作误诊71例,伴精神病性症状的为26例,误诊24例(92．31％).混合发作误诊1例,且伴精神病性症状.在首次发作的双相障碍的患者中,精神病性症状出现最频繁的为关系妄想(27例),其次为幻觉(10例).结论精神病性症状对于首次为抑郁发作的青少年患者来说对确诊双相情感障碍的意义更大.青少年双相请障碍患者出现精神病性症状的形式、内容广泛.重视精神病性症状在青少年双相障碍中的诊断作用,对提高双相障碍的识别率、诊断率有重大意义.     

双相情感障碍药物治疗进展

双相情感障碍是精神科常见疾病，病程复杂，治疗棘手，本文综述了双相情感障碍药物治疗的近期进展。     

难治性双相情感障碍的药物治疗

本文介绍了难治性双相情感障碍的诊断概念及药物治疗现状。     

双相情感障碍药物治疗进展

双相情感障碍是精神科常见疾病 ,病程复杂 ,治疗棘手 ,本文综述了双相情感障碍药物治疗的近期进展     

双相情感障碍的诊断

重性抑郁障碍(MDD)和双相障碍(BPD)并列为两种主要情感性障碍,据报道BPD约占人群的1.3%,美国BPD患者约300万,精神科临床的情感障碍中约50%是BPD,和MDD一样都是精神科常见病,多发病,是当今全球主要精神卫生总是,前些年由于各种新型抗抑郁药纷至潮来,一时间抗抑郁药和抑郁症成为公众热门话题,相形之下对BPD的重视却显得很不够,然而BPD的发作性,复发性特点尤为明显,致残率,死亡率相对高,治疗也更为棘手,本文就BPD的由来,分类,论断综述如下.     

双相情感障碍的治疗现状

本对近年来国外有关双相情感障碍之治疗的研究与观点进行介绍。     

快速循环型双相情感障碍的治疗策略

本介绍了目前对快速循环型双相情感障碍治疗的新动态，并在药物的有效性和病人的耐受性等资料基础上提出了一些治疗策略。     

Approaches to preventing relapse in bipolar disorder: addressing nonadherence and prodromal symptoms

The goals of maintenance treatment for euthymic patients with bipolar disorder are to prevent recurrence of acute episodes and to optimize the patient's adaptive functioning. Although medications are the primary treatment for preventing relapse, patient outcomes can be enhanced through the use of psychosocial interventions that address barriers to treatment success such as nonadherence to medication and lack of patient or caregiver understanding of the illness. Patients can learn to take an active and responsible role in managing their illness, including monitoring their symptoms to recognize prodromal signs of relapse, protecting daily social rhythms and routines, and maintaining healthy activities.     

Experiences of family caregivers of patients with bipolar disorder

Introduction: Attention to caregiving consequences has been mainly restricted to bipolar disorder, although studies suggest that relatives of bipolar patients also experience considerable distress. The purpose of this study was to explore the lived experiences of family member caregivers of bipolar disorder patients. Methods: In a qualitative research of phenomenological methodology, family member caregivers of bipolar disorder patients in Farshchian Psychiatric Hospital in Hamedan (Iran) were selected by purposive sampling in the year 2010. By reaching data saturation, the number of participants was 12. Data were gathered through in‐depth interviews and analyzed by van Manen method. Results: Analysis of the interviews revealed six major themes: fears and anxiety for the future, psychosomatic impact, feeling isolated and loneliness, financial impact, change in lifestyle and family functioning, and lack of support and knowledge. Discussion: This study highlights the need for family‐oriented mental health services to be developed and for further research to identify the specific nursing interventions that are effective in helping to sustain family caregiving.     

Burden on caregivers of older patients with bipolar disorder

Objectives: Available data suggest high burden on caregivers of patientswith bipolar disorder (BD), yet the well-being of patients with BD increasingly depends on family members, partners and close friends. Aspatients with BD get older, the need for informal care may shift. We aimed to describe the caregivers of older adults with BD (OABD) and explore what patients' and caregivers' characteristics are associated with caregiver burden.

Method: Forty-seven caregivers of OABD were questioned about their perceived burden and depressive symptoms. Linear regression analyses were performed to examine the influence of various patients' and caregivers' characteristics on caregiver burden or depression.

Results: More than half of all caregivers experienced some degree of burden,and 6.4% reported depressive symptoms. The number of psychiatric admissions and social functioning were the only patients' characteristics associated with higher burden. Caregiver burden was significantly associated with caregiver's other obligations. None of the patient or caregiver characteristics was significantly associated with depression in caregivers of OABD.

Conclusion: In OABD, even with few residual symptoms, more than half of all caregivers experience substantial burden. Future studies are needed to confirm if improving social functioning and preventing psychiatric hospitalizations decrease the burden on the caregivers of OABD.     

Ventricular enlargement in schizophrenia spectrum patients with prodromal symptoms of obsessive-compulsive disorder

We hypothesized that male patients with schizophrenia spectrum disorders who have prodromal symptoms of obsessive-compulsive disorder (OCD) have ventricular enlargement compared with non-psychotic OCD patients, and that the difference in the ventricular size would offer a clue to the early detection of schizophrenia spectrum disorders. The ventricle-brain ratios (VBRs) in eight male patients with schizophrenia or schizotypal personality disorder (SPD) who had prodromal symptoms of OCD were compared with eight male patients with non-psychotic OCD and 14 normal male comparison subjects using three-dimensional magnetic resonance imaging (MRI). The VBR of the schizophrenia spectrum group was significantly larger than those of the OCD group or comparison subjects. Even the minimum VBR in the schizophrenia spectrum group was larger than the maximum VBR in the OCD group. These results may suggest the usefulness of three-dimensional MRI for early detection of patients with schizophrenia spectrum disorders who manifest OCD symptoms early in the course of the illness.     

Facial emotion recognition in euthymic patients with bipolar disorder and their unaffected first-degree relatives

BackgroundFacial emotion recognition (FER) is an important task associated with social cognition because facial expression is a significant source of non-verbal information that guides interpersonal relationships. Increasing evidence suggests that bipolar disorder (BD) patients present deficits in FER and these deficits may be present in individuals at high genetic risk for BD. The aim of this study was to evaluate the occurrence of FER deficits in euthymic BD patients, their first-degree relatives, and healthy controls (HC) and to consider if these deficits might be regarded as an endophenotype candidate for BD.MethodsWe studied 23 patients with DSM-IV BD type I, 22 first-degree relatives of these patients, and 27 HC. We used the Penn Emotion Recognition Tests to evaluate tasks of FER, emotion discrimination, and emotional acuity. Patients were recruited from outpatient facilities at the Institute of Psychiatry of the University of Sao Paulo Medical School, or from the community through media advertisements, had to be euthymic, with age above 18 years old and a diagnosis of DSM-IV BD type I.ResultsEuthymic BD patients presented significantly fewer correct responses for fear, and significantly increased time to response to recognize happy faces when compared with HC, but not when compared with first-degree relatives. First-degree relatives did not significantly differ from HC on any of the emotion recognition tasks.ConclusionOur results suggest that deficits in FER are present in euthymic patients, but not in subjects at high genetic risk for BD. Thus, we have not found evidence to consider FER as an endophenotype candidate for BD.     

Psychopathy and facial emotion recognition ability in patients with bipolar affective disorder with or without delinquent behaviors

Background

It is well known that patients with bipolar disorder are more prone to violence and have more criminal behaviors than general population. A strong relationship between criminal behavior and inability to empathize and imperceptions to other person's feelings and facial expressions increases the risk of delinquent behaviors. In this study, we aimed to investigate the deficits of facial emotion recognition ability in euthymic bipolar patients who committed an offense and compare with non-delinquent euthymic patients with bipolar disorder.

Method

Fifty-five euthymic patients with delinquent behaviors and 54 non-delinquent euthymic bipolar patients as a control group were included in the study. Ekman's Facial Emotion Recognition Test, sociodemographic data, Hare Psychopathy Checklist, Hamilton Depression Rating Scale and Young Mania Rating Scale were applied to both groups.

Results

There were no significant differences between case and control groups in the meaning of average age, gender, level of education, mean age onset of disease and suicide attempt (p > 0.05). The three types of most committed delinquent behaviors in patients with euthymic bipolar disorder were as follows: injury (30.8%), threat or insult (20%) and homicide (12.7%). The best accurate percentage of identified facial emotion was “happy” (>99%, for both) while the worst misidentified facial emotion was “fear” in both groups (<50%, for both). The total accuracy rate of recognition toward facial emotions was significantly impaired in patients with delinquent behaviors than non-delinquent ones (p < 0.05). The accuracy rate of recognizing the fear expressions was significantly worse in the case group than in the control group (p < 0.05). In addition, it tended to be worse toward angry facial expressions in criminal euthymic bipolar patients. The response times toward happy, fear, disgusted and angry expressions had been significantly longer in the case group than in the control group (p < 0.05).

Conclusion

This study is the first, searching the ability of facial emotion recognition in euthymic patients with bipolar disorder who had delinquent behaviors. We have shown that patients with bipolar disorder who had delinquent behaviors may have some social interaction problems i.e., misrecognizing fearful and modestly anger facial emotions and need some more time to response facial emotions even in remission.     

Caregiver strain and symptoms of depression among principal caregivers of patients with schizophrenia and bipolar affective disorder in Sri Lanka

Introduction

Data on caregiver strain and depression of principal caregivers of patients with mental illnesses are few in developing countries. Findings from developed countries cannot be applied directly to developing countries as culture specific factors may influence the outcome.

Methods

A prospective study was carried out in the University Psychiatry Unit of the National Hospital of Sri Lanka (NHSL) to identify symptoms of depression, caregiver strain and dissatisfaction with life in caregivers of patients with schizophrenia and bipolar affective disorder. Participants were assessed using the Center for Epidemiological Studies – Depression Scale, Satisfaction with Life Scale and the Modified Caregiver Strain Index.

Results and discussion

Eighty caregivers were interviewed (males; 36, 45%). Symptoms of depression were significant in 37.5%, while 48.8% had unsatisfactory scores on the Satisfaction with Life Scale. Depression and higher caregiver strain were associated with spending more time with the patient, interruption to work, disputes with relations, being assaulted by patient and self admission of needing professional help to overcome mental stress.

Conclusion

This study identified several associations for depression and increased caregiver strain among caregivers in a subset of patients with mental disorder in Sri Lanka. These can be used as markers to screen and increase pretest probability to identify caregivers needing help rather than applying the cumbersome questionnaires to all.     

Depressive symptoms in patients with unipolar and bipolar affective disorder.

The study of biologic differences in patients with affective illness is dependent in part on a clinical classification which separates depressed patients into subgroups of greater homogeneity. The unipolar-bipolar classification is one such system, and the use of this classification has been supported by clinical, biologic, genetic, and pharmacologic studies of affective disorder.¹ This paper is part of a series of studies to determine if patients with depression and hypomania (“bipolar II”) can be distinguished from patients with depression and severe mania (“bipolar I”) and patients with depression without hypomania (unipolar).^2–4 In this paper, symptoms of depression, as measured with the use of a modified Hamilton depression rating scale,⁵ a nurses' global rating scale, and self-administered adjective check list, will be examined in moderately to severely depressed patients who were admitted to a clinical metabolic research unit.     

双相情感障碍抑郁发作急性期治疗后残留症状及其 影响因素

目的 探索双相障碍抑郁发作急性期治疗后的残留症状、功能损害及其影响因素。 方法 本研究为单中心、横断面研究，筛查2016 年2—12 月就诊于首都医科大学附属北京安定医院门 诊或住院的双相障碍且最近一次是抑郁发作的患者130 例。通过标准化的问卷及访谈过程收集人口学 资料、疾病临床特征。结果 共纳入121 例受试者，其中有残留抑郁症状患者23.1%（28/121）。临床痊 愈与残留抑郁症状两组在性别（χ2=17.90，P＜ 0.01）、急性期伴有睡眠障碍（χ2=7.37，P=0.01）、近2 年的 发作次数（Z=-2.46，P=0.01）等方面差异有统计学意义，二分类Logistic 回归显示男性、急性期伴有睡眠 障碍、近2 年发作次数多，均是急性期治疗后残留抑郁症状的独立危险因素。残留抑郁症状组各方面受 损程度较临床痊愈组严重，且与抑郁程度呈正相关。结论 双相障碍抑郁发作急性期治疗后部分患者 仍然存在残留的抑郁症状，其中男性、急性期伴有睡眠障碍、近2 年发作次数多是其危险因素，残留的 抑郁症状对患者影响严重，应该加强针对性治疗，以改善预后。     

Correlates of subjective and objective burden among caregivers of patients with bipolar disorder

Objective: We examined the relationship between mood symptoms and episodes in patients with bipolar disorder and burden reported by their primary caregivers. Method: Data on subjective and objective burden reported by 500 primary caregivers for 500 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD) were collected using semistructured interviews. Patient data were collected prospectively over 1 year. The relationship between patient course and subsequent caregiver burden was examined. Results: Episodes of patient depression, but not mood elevation, were associated with greater objective and subjective caregiver burden. Burden was associated with fewer patient days well over the previous year. Patient depression was associated with caregiver burden even after controlling for days well. Conclusion: Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects.