双相情感障碍教学查房.pptVIP

Summary of DSM-IV-TR Classification of Bipolar Disorders According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR), bipolar disorder can be divided into four classifications: Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified. Bipolar I Disorder is characterized by one or more manic or mixed episodes usually accompanied by major depressive episodes. Bipolar II Disorder focuses on one or more major depressive episodes accompanied by at least one hypomanic episode. A diagnosis of Cyclothymic Disorder is made when a patient experiences at least 2 years of numerous periods of hypomanic symptoms that do not meet the criteria for a manic episode and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode. Bipolar Disorder Not Otherwise Specified is characterized by bipolar features that do not meet the criteria for any of the specific bipolar disorders described above or for bipolar symptoms about which there is inadequate or contradictory information. Each classification of bipolar disorder is further defined by the presence (or history) of manic episodes, mixed episodes, or hypomanic episodes, usually accompanied by the presence (or history) of major depressive episodes. First, ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Rev. Washington, DC: American Psychiatric Association; 2000:345-428. 如前所述，双相障碍的特征是剧烈的心境摇摆。这个示意图描绘了这种疾病的多维性。在完全的躁狂发作和抑郁发作之间，患者可能还有亚综合征的抑郁或躁狂。 发作的缓解，无论是自行缓解还是通过治疗缓解，都可以使心境恢复正常，维持一段时间，然后到下一次发作。 有些患者可能在同一段时间内既符合躁狂发作的标准也符合抑郁发作的标准，这样就形成了混合发作状态。 双相情感障碍教学查房 慨念 双相障碍也称双相情感障碍，一般是指临床上具有躁狂发作或轻躁狂发作，又有抑郁发作的一类心境障碍。 在心境障碍的长期自然病程中，仅有躁狂或轻躁狂发作者非常少见（1%），所以ICD-10及DSM-5也归为双相障碍。 发病机制 一、分子遗传 遗传度高达85%，高于抑郁障碍、精神分裂症。父母中若一方患有双相障碍I型，其子女患双相障碍的概率为25%；若父母双方均患有双相障碍I型，其子女患双相障碍的概率为50%-70%。 发病机制 二、神经影像 1、结构性影像学 CT、MRI，反映脑部结构的形态学改变。双相障碍患者：前额叶、边缘系统局部灰质容量减少及白质结构异常，非特异