A型行为与情感性障碍

目的 为研究A型行为与情感性障碍的关系。方法 采用A型行为问卷评估120例情感性障碍患者与120例健康人的行为类型,并比较单、双相情感性障碍患者的行为类型。结果情感性障碍患者中A型行为占62.7％,显著高于正常对照组(43.9％)。单、双相情感性障碍者在行为类型方面有明显差别,双相以A型行为为主,单相者以B型行为多见;并发现反复发作性躁狂症者的行为类型与双相情感性障碍者类似。结论 情感性障碍患者以A型行为多见。单相躁狂症与双相情感性障碍应为情感性障碍同一临床亚型。     

妄想性和非妄想性抑郁症的遗传

目的：探索妄想性抑郁症的遗传情况。方法：对８１例妄想性抑郁症和１４０例非妄想性抑郁症的亲属进行了病历、家访和信函调查。结果：两组病人的亲属所患的精神疾病的总数无明显差异（Ｐ＞０．７５）；妄想性抑郁症病人的亲属所患的情感性精神障碍明显多于非妄想性抑郁症的亲属（Ｐ＜０．０５）；妄想性抑郁症的亲属所患的双相情感障碍也多于非妄想性抑郁症的亲属（Ｐ＜０．０２５）；而两组病人的亲属所患的妄想性抑郁症无明显差异（Ｐ＞０．５）。结论：妄想性抑郁症的亲属比非妄想性抑郁症的亲属易患情感性精神障碍和双相情感障碍     

单相抑郁与双相情感障碍遗传效应及方式的对照研究

为寻找情感性障碍可能是一组异源性疾病的根据，调查了１７例单相抑郁和９６例双相情感障碍患者一、二级亲属中的情感性障碍患病率，并对二组亚型的遗传效应及方式作了对照分析。结果显示，单相抑郁的家族聚集性明显高于双相情感障碍。单相抑郁和双相情感障碍的加权平均遗传率分别为１３１．２％和８８．９％。单相抑郁和双相情感障碍都符合多基因遗传，但单相抑郁的遗传率明显高于双相情感障碍，且单相抑郁的二级亲属同病者均集中在母系。提示两者可能属异源性疾病。     

10省市双相情感障碍患者药物治疗的现况调查

目的了解国内双相情感障碍患者精神药物的治疗现状。方法按一定的抽样比例，选择10个省市46家专科医院或综合医院精神科同时进行药物处方方式的调查。结果（1）在558例双相情感障碍患者中，躁狂相472例（84．6％），抑郁相86例（15．4％）；555（99．5％）例患者接受精神药物治疗。（2）主要治疗药物为心境稳定剂（80．7％），404例（72．8％）患者使用了抗精神病药。（3）躁狂相患者以心境稳定剂（84．7％）和抗精神病药（81．4％）单一或联合治疗为主，抑郁相患者单一或联合使用抗抑郁药的频率较高（80．2％）。（4）联合两种及其以上药物治疗者占80．2％。（5）145例（26．1％）患者合并使用了苯二氮Zhuo类药。结论国内双相情感障碍药物处方方式与国内外的指南推荐方案基本相符；双相障碍抑郁相抗抑郁药使用频率较高，有待于将来的临床实践论证。     

快速循环型双相情感障碍的治疗进展

快速循环型双相情感障碍(RCBD)最早由Dun-ner和Fieve于1974年提出。它的诊断标准为①符合双相情感性精神障碍的诊断标准;②躁狂和抑郁反复发作,每年至少4次,发作时分别符合躁狂发作和抑郁发作的诊断标准;③每次循环周期不短于48小时。它约占双相情感性精神障碍的15％～20％,多见于女性。尽管近年来,有关RCBD的研究不断增多,但它的治疗问题仍然困扰着临床医生。本文对RCBD当前的治疗方法作一综述。     

单相抑郁与以相情感障碍遗传效应及方式的对照研究

为寻找情感性障碍可以能是一组异源性疾病的根据，调查了１７例单相抑郁和９６例双相情感染障碍患者一、二亲属中的情感性障碍患病率，并对二组亚型的遗传效率及方式作了对照分析。结果显示，单相抑郁的家族聚集性明显高于双相情感障碍。单相抑郁和双相情感障碍的加权平均遗传率分别为１３１．２％和８８．９％。单相抑郁和双相情感障碍都符合多基因遗传，但单相抑郁的遗传率明显高于以相情感障碍，且单相抑郁的二极亲属同病者均集中     

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。     

快速与非快速循环型双相情感障碍临床对照分析

探讨快速循环型双相情感障碍的临床特征。方法对２０例快速循环与１７５例非快速循环型双相情感性精神障碍进行临床对照分析。ＲＣ组女性较多，初发年龄较小，多有阳性家庭史，以抑郁首发者较多，多为双相Ⅱ型。结论支持ＲＣ型作为双相障碍特殊亚型的观点。     

儿童少年情感性精神障碍42例临床分析

分析了42例儿童少年情感性精神障碍的临床资料。发现男：女为2．23：1,以双相情感障碍最多;多有精神病家族史,其性格特征多偏内向;发病多在春季,起病有一定的精神因素;临床症状及治疗与成人相仿,成人的诊断标准稍加修改可以用于儿童少年。     

双相情感性精神障碍与精神分裂症脑CT扫描比较

为了比较双相情感性精神障碍、精神分裂症病人脑结构的变化，收集符合国际疾病分类第１０版和中国精神疾病分类方案与诊断标准第２版修订本的双相情感性精神障碍病人２７例，以及精神分裂症病人２５例，应用脑ＣＴ定量分析脑室、脑沟。结果显示，双相情感性精神障碍和精神分裂症病人前角指数、第三脑室最大宽度、乳突间比值和脑萎缩差异均无显著性（Ｐ＞０．０５）。提示精神分裂症和双相情感性精神障碍这些所谓的功能性疾病可能和非特异性脑室、脑沟结构异常相关。     

Association between mood stabilizers and hypothyroidism in patients with bipolar disorders: a nested,matched case‐control study

Gau C‐S, Chang C‐J, Tsai F‐J, Chao P‐F, Gau SS‐F. Association between mood stabilizers and hypothyroidism in patients with bipolar disorders: a nested, matched case‐control study.
Bipolar Disord 2010: 12: 253–263. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S. Objectives: This study investigated whether lithium, carbamazepine, and valproate increased the risk for hypothyroidism using Taiwan’s National Health Insurance Dataset. Methods: The sample included 557 bipolar disorder patients with incident hypothyroidism first diagnosed between 1998 and 2004, and 2,228 sex‐, age‐, and index date‐matched bipolar disorder patients without hypothyroidism from 1996–2004. We compared the use of lithium, carbamazepine, and valproate before the onset of hypothyroidism between the two groups using a conditional logistical regression model. Results: Compared with patients who had never used any of the three mood stabilizers, patients were more likely to have hypothyroidism if they only used carbamazepine [odds ratio (OR) = 1.68; 95% confidence interval (CI): 1.07–2.65]; or comedication of lithium and valproate (OR = 2.40; 95% CI: 1.70–3.40), lithium and carbamazepine (OR = 1.52; 95% CI: 1.10–2.08), and three mood stabilizers (OR = 2.34; 95% CI: 1.68–3.25). There was a dose‐response relationship between the number of mood stabilizers and risk for hypothyroidism (OR = 1.34, 95% CI: 1.21–1.49) and a significant interaction between lithium and valproate on the risk for hypothyroidism (p = 0.020). Conclusions: Our findings indicate that lithium, carbamazepine, and valproate may increase the risk for hypothyroidism, particularly if combined, and suggest regular monitoring of thyroid function and monotherapy of mood stabilizers for treating patients with bipolar disorders.     

Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review

OBJECTIVE: To review and summarize the currently available data on the use of anticonvulsant mood stabilizers (carbamazepine, valproic acid, gabapentin, lamotrigine, topiramate) in the treatment of behavioral and psychological symptoms of dementia (BPSD); to determine whether these medications can be recommended for routine clinical use.METHODS: Literature search in five databases (PubMed, MEDLINE, EMBASE, PsychINFO and COCHRANE collaboration) and analysis of the randomized controlled double-blinded clinical trials found therein.RESULTS: A total of seven RCTs were identified (two for carbamazepine and five for valproate). One study showed statistically significant improvement of BPSD in the medication group in comparison to the placebo group; five studies showed no significant differences; one study showed statistically significant worsening of the symptoms in the medication group vs. placebo. The majority of the studies reported significantly more frequent adverse effects in the medication group.CONCLUSION: Although clearly beneficial in some patients, anticonvulsant mood stabilizers cannot be recommended for routine use in the treatment of BPSD at the present time.     

Self-reported adherence to treatment with mood stabilizers,plasma levels,and psychiatric hospitalization

OBJECTIVE: The authors explored the relationship of adherence to treatment with mood stabilizers (lithium, carbamazepine, and sodium valproate) and plasma levels of these drugs to future psychiatric hospitalizations. METHOD: They prospectively followed 98 patients with mood disorders who were prescribed mood stabilizers. These patients participated in an initial interview and completed a questionnaire regarding their adherence to the medications. Data on their plasma levels of these drugs were taken from assays done in the 3 months before the interview. RESULTS: Six of the 98 patients were not classified as to medication adherence or plasma levels. Twenty-nine (32%) of the remaining patients reported partial adherence to the medication regimen, and 33 (36%) had an index plasma level that was suboptimal. At 18 months, rates of admission to a psychiatric hospital were significantly higher in the 16 partially adherent patients with subtherapeutic plasma levels (N=13, 81%) than in the 46 adherent patients with therapeutic plasma levels (N=4, 9%). However, hospital admission was also more likely in partially adherent patients with therapeutic plasma levels than in adherent patients with subtherapeutic plasma levels. CONCLUSIONS: Adherence to medication regimens may be a proxy measure of other healthy behaviors.     

Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders

OBJECTIVE: Bipolar disorders are prevalent major illnesses with high rates of morbidity, comorbidity, disability, and mortality. A growing number of psychotropic drugs are used to treat bipolar disorder, often off-label and in untested, complex combinations. METHODS: To quantify utilization rates for psychotropic drug classes, this study used the 2002-2003 U.S. national MarketScan research databases to identify 7,760 persons with ICD-9 bipolar disorder subtypes. Survival analysis was used to estimate times until initial monotherapies were augmented, changed, or discontinued. RESULTS: The most commonly prescribed first drug class was antidepressants (50% of patients), followed by mood stabilizers (25%: anticonvulsants, 17%, and lithium, 8%), sedatives (15%), and antipsychotics (11%). At study midpoint only 44% of patients were receiving monotherapy. Those receiving monotherapy were ranked by initial drug prescribed and percentage of patients (bipolar I and bipolar II): antidepressants (55% and 65%), lithium (51% and 41%), antipsychotics (32% and 31%), anticonvulsants (28% and 29%), and sedatives (28%, 25%). Median time to adding another psychotropic was 2.5-times less than median time to changing the initial treatment (16.4 compared with 40.9 weeks), and stopping was rare. Median weeks until therapy was changed in any way for 25% of patients was as follows: lithium, 29 weeks; antidepressants, 13; anticonvulsants, 13; antipsychotics, 13; and sedatives, 9. CONCLUSIONS: Antidepressants were the first-choice agent twice as often as mood stabilizers. Lithium was sustained longer than monotherapy with other mood stabilizers. Time to augmentation was much shorter than time to change or discontinuation.     

Mood stabilizers in the prevention of recurrent affective disorders: a meta-analysis

OBJECTIVE: To determine by meta-analysis the efficacy of mood stabilizers in preventing recurrence of bipolar or unipolar mood disorders and to consider the evidence for a lithium withdrawal-induced relapse syndrome. METHOD: Controlled studies of lithium, valproate and carbamazepine in preventing future episodes of affective disorders were classified according to methodological rigour, and meta-analyses were performed overall and on each type. RESULTS: A total of 19 blinded, randomized, controlled trials of prophylaxis in 865 patients found lithium highly effective (74% recurrence on placebo vs. 29% on lithium). In the mirror-image studies, whose substantial lithium vs. prior treatment difference cannot be explained by withdrawal relapse, lithium reduced relapse by 50% (bipolar) and 58%(unipolar). CONCLUSION: Maintenance lithium produces a highly significant reduction in relapses. The mirror-image studies had not been systematically analysed previously, and they support the effectiveness of lithium. We also failed to find sufficient evidence to prove that the lithium-withdrawal relapse phenomenon exists.     

Critical role of brain-derived neurotrophic factor in mood disorders

The purpose of this review is to integrate what is currently known about the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of mood disorders including major depressive disorder (MDD) and bipolar disorder (BD). We reviewed the pre-clinical and clinical papers demonstrating that BDNF plays a role in the pathophysiology of mood disorders and in the mechanism of action of therapeutic agents. Pre-clinical studies suggest that the expression of BDNF might be a downstream target of antidepressant treatments and mood stabilizers such as lithium and valproate, and that BDNF exerts antidepressant activity in animal models of depression. Furthermore, BDNF protects against stress-induced neuronal damage, and it might affect neurogenesis in the hippocampus, which is thought to be involved in the pathogenesis of mood disorders. Clinical studies have demonstrated that serum levels of BDNF in drug-naive patients with MDD are significantly decreased as compared with normal controls, and that BDNF might be an important agent for therapeutic recovery from MDD. Moreover, recent findings from family-based association studies have suggested that the BDNF gene is a potential risk locus for the development of BD. These findings suggest that BDNF plays a critical role in the pathophysiology of mood disorders and in the activity of therapeutic agents in patients with mood disorders. New agents capable of enhancing BDNF levels may lead aid the development of novel therapeutic drugs for patients with mood disorders.     

Previous mood state predicts response and switch rates in patients with bipolar depression

OBJECTIVE: The treatment of bipolar depression is a significant clinical problem that remains understudied. The role for antidepressant (AD) agents vs. mood stabilizers has been particularly problematic to ascertain. METHOD: Detailed life charting data from 42 patients with 67 depressive episodes were reviewed. Response rates and rates of switch into mania were compared based on the preceding mood state and on whether an AD or mood stabilizing (MS) agent was added following onset of depression. RESULTS: Patients who became depressed following a period of euthymia were more likely to respond to treatment (62.5%) than patients who became depressed following a period of mania or hypomania (27.9%). The ratio of response to switch for previously euthymic patients was particularly favorable. CONCLUSION: Mood state prior to onset of depression in bipolar disorder appears to be an important clinical variable that may guide both choice of treatment administered and expectation of outcome to treatment.     

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.     

Psychotropic medication use mediates the relationship between mood and anxiety disorders and obesity: Findings from a nationally representative sample

Growing evidence points to a relationship between obesity and both mood and anxiety disorders, but the question of what accounts for this association remains unanswered. The present study examined the use of psychotropic medications as a mediator of the mood/anxiety disorder-obesity relationship. Data came from the public use dataset of the Canadian Community Health Survey Cycle 1.2 (age 15 years and older, N = 36,984). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnoses of 12-month mood disorders (e.g., major depressive disorder, mania) and anxiety disorders (e.g., panic attacks, panic disorder, social phobia, agoraphobia) were examined as was use of psychotropic medications (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics, mood stabilizers) and obesity (defined as body mass index ≥30). A series of multiple logistic regression analyses were completed to test study hypotheses. Covariates in these analyses included sociodemographic factors, physical activity, and physical illness burden. The use of two medication classes, namely antidepressants and antipsychotics, emerged as significant predictors of obesity as well as mediators of the psychiatric diagnosis-obesity relationship after evaluating all psychotropic medication classes simultaneously, while also controlling for other theoretically relevant variables. The use of these two medications accounted for 86% of the relationship between mood disorders and obesity and 32% of the relationship between anxiety disorders and obesity. The study findings guide advances in the theoretical conceptualization of the mechanisms involved in mood/anxiety disorder-obesity relations. Clinical implications are discussed.