两性畸形伴发精神障碍1例

1病例患者,女,32岁,汉族。因"反复情绪低落、消极悲观伴夜眠差14年"于2012年2月13日入院。患者因第二性征发育不良、无月经曾于1998年(18岁)在某医院染色体检查为正常男性核型;之后渐渐出现情绪低落,紧张、烦躁、悲观,甚     

血清素综合症1例报道

患者男性，４６岁，因反复情绪低落、高涨１２年，情绪低落１个月入院。患者于１２年前出现情绪低落，食欲体重下降，失眠，于我科诊断为“抑郁症”，给予阿米替林治愈，之后反复５次出现情况低落，间杂以２次情绪高涨，兴奋话多。１个月前再发情绪低落、失眠，缺乏兴趣，...     

原发性醛固酮增多症误诊为抑郁症1例

<正>1病例患者:女性,35岁,本科,公务员。因"情绪低落、失眠、自责及自杀观念1年,一过性黑朦1 d"于2012年11月27日收治本院。患者1年前离婚后出现情绪低落,觉得活着没意思,入睡困难、睡眠浅、早醒;工作能力下降,几乎每天出现自杀想法。曾两次来我院心理咨询并求治精神科,给予"帕罗西汀、丁螺环酮、多虑平"治疗,但未按嘱服药。因今天出现黑朦、失聪、站立不稳,约1 min自行缓解而就诊入院。近     

抑郁发作合并神经源性膀胱一例北大核心CSCD

临床资料患者女,71岁,丧偶。因“腰椎手术后出现情绪低落、少言懒动10个月,加重伴排尿困难1个月余”,于2016年6月12日人住我院。2015年7月患者于外院行“腰椎压缩性骨折经皮穿刺椎体成形术”,术后下肢行走功能恢复缓慢。于8月出院后出现情绪不佳,经常默默流泪,话少,食欲差,便秘。渐不出门,不愿见邻居好友,认为自己没用,拖累儿子,对将来悲观,伴疲乏无力、头昏,未予诊治。     

双相障碍女性患者性欲亢进一例北大核心CSCD

患者 女,58岁。因情绪低落30年,性欲亢进20年,于2013年5月17日来我院门诊治疗。在治疗过程中出现兴奋2个月余。患者于1983年因婆媳关系不好经常吵架、打架,曾想撞车、喝农药自杀。3年后与婆婆分开住,但为家庭房产仍吵架、打架。丈夫帮着家人,患者更伤心。至1993年上半年某日早晨醒来突然感到阴部不适,有性要求。一般每天出现2～3次,最多6～7次,偶有1个月不出现。曾在泌尿科、妇产科检查无阳性发现。夜眠差,饮食、二便均正常。     

米氮平治疗病例综合分析

患者1 男性,71岁,退休工人.因"情绪低落3年,复发伴腹痛2个月,加重1个月"入院.现病史:患者3年前因他人赊账1万余元不还,顾虑家人责问,渐感担心,常整夜难入睡,继之出现情绪低落、兴趣下降、活动减少,他人还钱后上述情况仍无缓解,遂由家人陪同到我科门诊就诊,诊断为抑郁症.     

以剧烈头痛、血压明显升高为主要表现的1例惊恐障碍报告

1病例 患者,男,71岁,因＂情绪低落、兴趣减退、精力减退伴频繁出现阵发性剧烈头痛、恐惧、气短两年加重两个月＂入院。患者两年前无明显诱因出现情绪低落,兴趣减退,不愿见人,言语活动减少,精力减退,并渐出现阵发性剧烈头痛,常常每日发作数次,头痛时,痛不欲生,血压明显升高,     

复方氨酚烷胺胶囊所致精神障碍1例

正1病例患者女性,43岁,汉族,无业。因"长期服用复方氨酚烷胺胶囊出现情绪低落、头痛、紧张、手抖伴睡眠差,间断2年"于2014年8月28日首次就诊我院我科。2009年起患者紧张时自觉头痛就经常超量服用复方氨酚烷胺胶囊(商品名:仁和可立克),每日4~12片,以此缓解头痛。患者于2012年无明显诱因出现入睡困难,有时整夜不睡,烦躁焦虑,做事能力下降,不愿与人交往,自觉头脑反应变慢。当时未重视     

抑郁与疼痛需求(附1例报告)

患者赵某，男，16岁。因情绪低落、懒动、缺乏兴趣2月余于2006年12月13日来诊。 患者于2个月前因恋爱受挫出现失眠，情绪低落，整日愁眉不展，唉声叹气，对任何事情均不感兴趣，想高兴高兴不起来，自感反应迟钝，读书读不进去，懒动，屡次用刀片划前臂掌侧，划痛时心里感到舒服，越痛越舒服，患者述用刀片划前臂不是为了自杀，而是为了舒服，虽想死，但是不敢自杀，未经治疗。     

蓄意自伤综合征1例报告

患者,男性,44岁,已婚。因多次情绪低落时使用针刺伤小腿20余年,于2001年11月20日来门诊咨询。20年前,患者复员退伍回家,由于家境差,婚姻受挫,加之患者有手淫的习惯,便出现自卑,情绪低落,活动减少,整日无精打彩,时有轻生的念头。这期间患者偶而听村中的老中医说     

Depression with DSM-IV atypical features: a marker for bipolar II disorder

The aim of the study was to find the prevalence of atypical features in bipolar II depression versus unipolar depression. Five hundred and fifty seven unipolar and bipolar II depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. DSM-IV atypical features were significantly more common in bipolar II patients than in unipolar patients (45.4% vs 25.4%, odds ratio 2.4). As the diagnosis of bipolar II disorder is often based on diagnosis of past hypomania, which may not be very reliable, depression with atypical features may point to bipolar II disorder diagnosis. Received: 18 February 1999 / Accepted: 29 October 1999     

Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response

Objectives:  There is little evidence for differences in response and speed of response to electroconvulsive therapy (ECT) between patients with bipolar and patients with unipolar depressive disorder. In the only prospective study to date, Daly et al. (Bipolar Disord 2001; 3: 95–104) found patients with bipolar depression to show more rapid clinical improvement and require fewer treatments than unipolar patients. In this study, response and speed of response of patients with unipolar and bipolar depression treated with ultra-brief pulse ECT were compared.
Methods:  All patients (n = 64) participated in a randomized trial comparing ultra-brief pulse bifrontal ECT at 1.5 times seizure threshold and unilateral ECT at 6 times seizure threshold. Thirteen patients (20.3%) had DSM-IV-defined bipolar depression. The Hamilton Rating Scale for Depression and Clinical Global Impression scale were administered at baseline and repeated weekly during and after the course of treatment by a blinded rater. At the same time point, the Beck Depression Inventory and the Patient Global Impression scale were administered. Speed of response was analyzed using survival analyses.
Results:  Patients with bipolar and unipolar depression did not differ in rates of response or remission following the ECT course, nor in response to unilateral or bifrontal ECT. Patients with bipolar depression, however, showed a more rapid response than patients with unipolar depression.
Conclusions:  Patients with bipolar depression tend to show more rapid clinical improvement with ECT than patients with unipolar depression.     

Prevalence of bipolar II disorder in atypical depression

The diagnostic validity of atypical depression is based on its superior response to monoamine oxidase inhibitors compared to tricyclic antidepressants, and on latent class analysis. The studies on atypical depression have often not included bipolar patients. The aim of the present study was to find the prevalence of bipolar II disorder among DSM-IV atypical depression outpatients. Bipolar II and unipolar atypical depressions were also compared to find if they were variants of the same disorder or if instead they were different disorders. One hundred and forty consecutive unipolar and bipolar II outpatients, presenting for treatment of an atypical major depressive episode, were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning Scale. The prevalence of bipolar II disorder was 64.2%. The age at baseline and onset were significantly lower in bipolar II versus unipolar patients. All the other variables (MADRS items, duration of illness, severity, gender, psychosis, comorbidity, chronicity, recurrences) were not significantly different. The prevalence of bipolar II disorder among atypical depressed outpatients was higher than previously reported. Received: 27 July 1998 / Accepted: 19 January 1999     

抑郁症门诊患者中未识别出的双相障碍者的临床特征（英文）

背景双相障碍常未被识别或被误诊为单相抑郁。明确未被识别或被误诊的双相障碍者的临床特征有助于减少错误分类。目的调查门诊抑郁症患者中未被识别的双相障碍者的比例,并分析未被识别的双相障碍者的临床特征。方法使用32项轻躁狂症状清单（Hypomania Checklist-32,HCL-32）、心境障碍问卷（Mood Disorder Questionnaire,MDQ）和简明国际神经精神访谈（Mini International Neuropsychiatric Interview,MINI）对目前被诊断为抑郁症的100例门诊患者进行调查。对被重新诊断为双相障碍与仍然被诊断为抑郁症的患者的临床特征进行比较分析。结果共有29例（29%）抑郁症门诊患者被诊断为双相障碍;其中双相Ⅰ型6例,双相Ⅱ型23例。与未更改诊断的抑郁症者相比,被重新诊断为双相障碍者年龄轻、起病早、发病次数多、受教育程度高,多为复发性抑郁且多伴精神病性症状。多因素Logistic回归分析显示年龄（OR=0.55,95%CI=0.34~0.89）和精神病性症状（OR=9.12,95%CI=1.56~53.26）是双相障碍的独立危险因素。结论在门诊抑郁症患者中未被识别的双相障碍比例较高,尤其是双相Ⅱ型。与单相抑郁相比,诊断为抑郁症而为未被识别的双相障碍者年龄轻,更可能伴有精神病性症状。     

单相抑郁与双相障碍住院患者地塞米松抑制试验的对照研究

目的 通过地塞米松抑制试验(DST)了解单相抑郁和双相障碍患者在不同情绪状态下的下丘脑-垂体-肾上腺轴功能改变情况. 方法对38例单相抑郁住院患者和63例双相障碍住院患者(双相障碍Ⅰ型19例,双相障碍Ⅱ型44例;双相障碍抑郁发作者33例,双相障碍躁狂发作者18例,双相障碍混合发作者12例)进行DST,其中17例单相抑郁、35例双相障碍患者在治疗4周后再次行DST,比较各组DST脱抑制率差异.结果 治疗前,单相抑郁的DST脱抑制率(36.8%)与双相障碍(14.3%)、双相障碍Ⅰ型(10.5%)、双相障碍Ⅱ型(15.9%)以及双相障碍抑郁发作(15.2%)之间比较差异有统计学意义(P<0.05);双相障碍Ⅰ型(10.5%)与双相障碍Ⅱ型(15.9%)之间,双相障碍抑郁发作(15.2%)、双相障碍混合发作(16.7%)和双相障碍躁狂发作(11.1%)两两比较差异均无统计学意义(P>0.05).治疗后,DST脱抑制率在上述各组间差异无统计学意义(P>0.05).治疗后单相抑郁的DST脱抑制率随着病情改善而降低,但较治疗前差异无统计学意义(P>0.05),双相障碍的DST脱抑制率在治疗前后比较差异无统计学意义(P>0.05).结论在疾病期,单相抑郁的DST脱抑制率高于双相障碍;双相障碍的DST脱抑制率与临床分型、发作类型、病情无关.     

A two-illness model of bipolar disorder

The current approach to mood disorders is that bipolar disorder, comprising both mania and depression, is a discreet illness distinct from unipolar depression. This formulation has profoundly influenced the approach to understanding the biology and etiology of these disorders, as well as the manner in which the various phases of bipolar disorder are treated. Our new model suggests that bipolar disorder comprises two distinct illnesses, mania and depression, and that bipolar depression is no different from unipolar depression. Studies of clinical syndromes, course of illness, family history and genetics, biological factors, and treatment response data directly or indirectly support this new model.     

Identifying functional neuroimaging biomarkers of bipolar disorder: toward DSM-V

Bipolar disorder is one of the most debilitating and common illnesses worldwide. Individuals with bipolar disorder frequently present to clinical services when depressed but are often misdiagnosed with unipolar depression, leading to inadequate treatment and poor outcome. Increased accuracy in diagnosing bipolar disorder, especially during depression, is therefore a key long-term goal to improve the mental health of individuals with the disorder. The attainment of this goal can be facilitated by identifying biomarkers reflecting pathophysiologic processes in bipolar disorder, namely impaired emotion regulation, impaired attention, and distractibility, which persist during depression and remission and are not common to unipolar depression. In this critical review, we examine the feasibility of identifying biomarker of bipolar disorder by discussing existing findings regarding functional abnormalities in neural systems underlying emotion processing (amygdala centered), working memory, and attention (dorsolateral prefrontal cortex centered) that persist through bipolar depression and remission and are bipolar specific rather than common to unipolar depression. We then focus on future research goals relating to major clinical problems in bipolar disorder, including, the identification of biomarkers allowing detection of individuals at risk of subsequent development of the disorder. Bipolar disorder is a common, debilitating, and potentially fatal disorder. Current and future research in bipolar disorder should focus on identification of disorder biomarkers to improve diagnostic accuracy and the mental heath of those with the disorder.     

Bipolar-panic disorder comorbidity within bipolar disorder families: a study of siblings

Objectives:  Although anxiety disorders often co-occur with bipolar disorder in clinical settings, relatively few studies of bipolar disorder have looked specifically at panic comorbidity. This report examines lifetime panic comorbidity within a sample of families with a history of bipolar disorder.
Methods:  One hundred and nine probands with bipolar disorder and their 226 siblings were interviewed as part of a family-genetic study. Logistic regression was used to model bipolar disorder as a predictor of comorbid panic in those with affective disorder, with age at interview and gender included as covariates.
Results:  The percentage with panic attacks was low in those without affective disorder (3%) compared with those with unipolar depression (22%) or bipolar disorder (32%). Panic disorder was found only in those with affective disorder (6% for unipolar, 16% for bipolar). When bipolar disorder and unipolar disorder were compared, controlling for age and sex, having bipolar disorder was associated with panic disorder (OR = 3.0, 95% CI = 1.1, 7.8) and any panic symptoms (OR = 2.0, CI = 1.0,3.8) and more weakly with the combination of panic disorder and recurrent attacks (OR = 1.8, CI = 0.9, 3.5).
Conclusions:  The absence of panic disorder and the low prevalence of any panic symptoms in those without bipolar or unipolar disorder suggest that panic is associated primarily with affective disorder within families with a history of bipolar disorder. Furthermore, panic disorder and symptoms are more common in bipolar disorder than in unipolar disorder in these families.     

The distinction of bipolar II disorder from bipolar I and recurrent unipolar depression: results of a controlled family study

The aim of the study was to differentiate bipolar II, bipolar I and recurrent unipolar depression by their familial load for affective disorders. Eighty bipolar, 108 unipolar, 80 control subjects and interviewed first-degree relatives were diagnosed according to Research Diagnostic Criteria using the Schedule for Affective Disorders and Schizophrenia – lifetime version. The morbid risks for bipolar I disorder were equivalent in relatives of bipolar I (3.6%) and bipolar II (3.5%) subjects and lower in relatives of unipolar subjects (1.0%). The morbid risks of relatives for bipolar II disorder distinguished bipolar II subjects (6.1%) from bipolar I subjects (1.8%), from unipolar depressives (0.3%) and from controls (0.5%). To promote further evaluation, bipolar II disorder should be included in DSM-IV as a distinct diagnostic category.     

单相与双相抑郁症患者沉思反应及拖延行为的比较

目的:探讨单相与双相抑郁患者沉思反应及拖延行为的差异。方法:对32例单相抑郁(单相组)及31例双相抑郁(双相组)患者分别评定沉思量表(RRS)、一般拖延行为问卷(GPS)和汉密尔顿抑郁量表(HAMD-17)评定;对26名正常对照者(健康组)给予RRS和GPS评定,然后进行组间比较。结果:抑郁组的RRS总分(55.8±9.5)显著高于健康组[(45.8±8.1),P0.01)],抑郁组的GPS总分(57.2±8.9)也显著高于健康组[(49.3±8.4),P0.05];单相组和双相组的RRS总分及GPS总分与HAMD总分及阻滞、绝望感因子分均呈显著正相关(r=0.368~0.491,P0.05或P0.01);单相组与双相组的RRS总分及各因子分和GPS总分差异无统计学意义(P0.05)。结论:抑郁症患者比健康人更易陷入沉思,且也较易采取拖延方式;单相与双相抑郁症患者的沉思反应及拖延行为未见实质性差别,但在临床上需加以关注。