心境障碍(英文).ppt

心境障碍(英文).ppt

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精神病学精神病学Affective（mood）DisordersXIEGuang-rongM.D.DefinitionAffectivedisordersarecharacterizedbyobviousandpersistentelationordepressionofmood.Themooddisturbanceiscommonlyassociatedwithcognitiveandbehavioralchanges.Inseverecases,psychoticsymptoms,suchashallucinationanddelusion,maybeobserved.Thereisarecurrenttendency.Incertaincases,anepisodemaybecomechronicandresidualsymptomsareobserved.TheClassificationofAffectiveDisordersManicepisode（mania）Depressionsingleepisode（unipolar）recurrentepisodeWithorAffectivewithoutDisordersBipolar-I（withmania）PsychoticBipolarBipolar-II（withhypomania）symptomdisordersMixedtypeRapid-cyclingbipolardisorderDysthymiaCyclothymiadisorderClinicaldescriptionofmooddisordersTheepisodeSeverityMild,moderate,orsevereTypeDepressive,manic,mixedSpecialfeaturesWithmelancholicsymptomsWithneuroticsymptomsWithpsychoticsymptomsWithagitationWithretardationorstuporThecourseUnipolarorbipolarAetiologyPredominantlyreactivePredominantlyendogenousEtiologyGeneticCausesFamilyStudies:

InastudyattheNationalInstituteofMentalHealth,25%ofrelativesofbipolarprobandswerefoundtohavebipolardisorderorunipolarillness（depression）themselves,comparedto20%ofrelativesofunipolarprobandsand7%ofrelativesofcontrolsubjects.Somedatahavesupportedmultifactorialmodels,Thesemodelsimplymultiplefactors:

genetic,environmental,orboth.Analternativeexplanationisheterogeneity.Inotherwords,singlemajorgenesareimportantinatleastsomefamilies,butitisnotthesamegeneineachfamily.Twinstudies:

Onaverage,MZtwinpairsshowconcordance65%ofthetime,andDZtwinpairsshowconcordance14%ofthetime.AdoptionStudies:

Inonestudy,theriskforaffectivedisorderinthebiologicalrelativesofbipolarprobandswas31%asopposedto2%intherelativesofcontrolprobands.Theriskinbiologicalrelativesofadoptedbipolarprobandswassimilartotheriskinrelativesofbipolarprobandswhowerenotadoptedaway（26%）.Adoptiverelativesdidnotshowincreasedrisk.Adoptionstudiesthatusedabroaderclassofaffectiveprobandsshowedevidenceforgeneticfactorsbutalsopossibleenvironmentalinfluences.MolecularGeneticsLinkageStudiesChromosomalLocationReference18pBerrettinietal19Stineetal199521qStraubetal1994Detera-Wadleighetal1996Xq26Pekkarinenetal199511p15Egelandetal1987Kelsoeetal1991Gurlingetal19955qCoonetal19934pBlackwoodetal199618qFreimeretal1996Stineetal1995Other（including10p,12q）Craddocketal1994Ewaldetal1995Ginnsetal1996NIMHGeneticsInitiative1997SummarynThelifetimeriskforsevereaffectivedisorderisabout8%.Riskisincreasedtoabout20%infirst-degreerelativesofunipolarpatientsandto25%infirst-degreerelativesofbipolarpatients.Riskappearstobe40%inrelativesofschizoaffectivepatients.Therisktooffspringoftwoaffectivelyillparentsismorethan50%.Overallriskfiguresappeartoberisinginrecentyears.BiologicaltheoriesNeurotransmitters.Wenowknowthatallclinicallyeffectiveantidepressantsincreaseneurotransmitterconcentrationsatpostsynapticreceptorsitesbyinhibitingtheirreuptake（intothepresynapticneuron）fromthesynapticcleft,Thisactionhasledtothehypothesisthatdepressioniscausedbyaneurotransmitterdeficiencyandthatantidepressantsexerttheirclinicaleffectbytreatingthisimbalance.Theserotonin-norepinephrine-gluco-corticoidlinkhypothesisofaffectivedisorders.Neuroendocrinefactors.Thetwoendocrinesystemsmostextensivelystudiedinpsychiatryarethehypothalamic-pituitary-adrenal（HPA）axisandthehypothalamic-pituitary-thyroid（HPT）axis.Abouthalfofpatientswithmajordepressionexhibitcortisolhypersecretionthatreturnstonormaloncethedepressioniscured.LifeeventsRecentevidenceconfirmsthatcruciallifeevents,particularlythedeathoflossofalovedone,canprecedetheonsetofdepression.However,suchlossesprecedeonlyasmallnumberofcasesofdepression.Fewerthan20%ofindividualsexperiencinglossesbecomeclinicallydepressed.Theseobservationsarguestronglyforapredisposingfactor,possiblygenetic,psychosocial,orcharacterologicalinnature.DepressiveepisodeDefinitionThedisorderischaracterizedbydepressedmoodthatisoutofkeepingwiththecircumstances.Itmayvaryfromlowmoodtomelancholia,orevenstupor.Inseverecases,psychoticsymptoms,suchasdelusionsandhallucinations,maybepresent.EpidemiologySymptomsanddisordersofthedepressionspectrumarerathercommon.Lifetimeprevalenceratesfordepressivesymptomsare13%20%andformajordepressivedisorder3.7%6.7%.Majordepressivedisorderisabouttwotothreetimesascommoninadolescentandadultfemalesasinadolescentandadultmales.Inprepubertalchildren,boysandgirlsareaffectedequally.Ratesinwomenandmenarehighestinthe25-to44-year-oldagegroup.Signs&SymptomsMajordepressiveepisodeThecardinalfeatureofamajordepressiveepisodeisadepressedmoodorthelossofinterestorpleasurethatpredominatesforatleast2weeksandcausessignificantdistressorimpairmentintheindividualssocial,occupational,orotherimportantareasoffunctioning.1.Depressedmood.Depressedmoodisthemostcharacteristicsymptom,occurringinover90%ofpatients.Thepatientusuallydescribeshimselforherselfasfeelingsad,low,empty,hopeless,gloomy,ordow