综合医院医学心理门诊中双相情感障碍的诊断

目的 了解门诊双相情感障碍及其快速循环型的漏诊、误诊情况，同时寻找提示快速循环型发病的相关因素。方法 回顾性病例对照研究，从流行病学、临床演变过程等多方面分析医学心理门诊中35例快速循环型（RC）和62例非快速循环型（NRC）双相情感障碍患者的病史和诊治特点。结果 门诊双相情感障碍的漏诊和误诊率分别为42．3％（41／97）、3．1％（3／97），其中快速循环型分别为62．9％（22／35）、2．9％（1／35）。首次发病形式以混合状态者RC（26．7％，8／30）显著多于NRC（5．6％，3／53），其中女性RC情感障碍发作与月经周期有关者为28．6％（6／21），显著多于NRC。首次发病年龄、阳性家族史、自杀行为等在RC与NRC之间差别无显著性。结论 临床医师应该对情感障碍患者需要注意两极情感状态变化的追询，以便及时诊断和合适地治疗。首次发病形式为情感抑郁－兴奋混合表现以及发病与月经周期有关的女性可能提示RC。

Diagnosis and treatment for outpatients with bipolar affective disorders

Objective To know how many patients with bipolar or with rapid cycling bipolar disorder were underdiagnosed or misdiagnosed in psychological counseling clinic at general hospital, and to find out risk factors associated with rapid cycling. Methods It was a retrospective case controlled study and was conducted on outpatients who meeting criteria of CCMD 2 R bipolar disorder. Thirty five rapid cycling patients were compared with 62 non rapid cycling patients on several demographic and clinical variables. Results There were 42.3% bipolar patients underdiagnosed, and 3.1% bipolar patients misdiagnosed. The percentage of underdiagnosis on patients with rapid cycling was 62.9%, and that of misdiagnosis was 2.9%. Patients who experienced mixed state as first affective episode were significantly more among rapid cycling group (26.7%) than those among non rapid cycling group (5.6%). There were 28.6% women among rapid cycling group whose affective episodes related to the menstrual cycle, while there was no such condition among non rapid cycling group. There was no significant difference between two groups on the age at onset, family history, and suicide behavior. Conclusion The percentages of underdiagnosis are high in outpatients with bipolar disorder and in those with rapid cycling bipolar. It needs to pay attention to the variations between affective poles, in order to diagnosis timely and management properly.