小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 重性抑郁发作
- 躁狂发作或混合发作
- 轻躁狂发作
- 自尊心膨胀或自大
- 睡眠需求降低
- 比平时更多话，或者感觉有压力要不停地说话
- 思维奔逸，或者主观体验到思维奔逸
- 注意力分散
- 目的导向的活动增加或精神运动性激越
- 过度参与很可能带来不利后果的快感活动
- 功能障碍
- 无物质滥用
- 无潜在躯体疾病原因
- 不应由身体抗抑郁药物治疗或其他处方药引起
危险因素
- 双相情感障碍家族史
- 在 20 岁前出现心境障碍发作
- 应激性的生活事件
- 抑郁既往史
- 物质滥用障碍的终身病史
- 出现焦虑障碍
- 肥胖
- 心血管疾病
诊断性检查
首要检查
- 精神疾病的初级医疗保健评估 (PRIME-MD)
- 患者健康问卷 (PHQ-9)
- 心境障碍问卷调查 (MDQ)
- 复合性国际诊断访谈 (CIDI)
- 双极性指数
- 杨氏躁狂评定量表 (YMRS)
- 全血细胞计数（FBC）
- 甲状腺功能检测
- 血清维生素 D
- 毒理学筛查
需考虑的检查
- 空腹血脂检查
- 空腹血糖
- 颅脑 MRI 扫描
- 活动记录仪检查
治疗流程
非快速循环伴急性躁狂、轻症躁狂或混合特征：非妊娠
非快速循环伴急性双相 I 型抑郁：非妊娠
非快速循环伴急性双相 II 型抑郁：非妊娠
快速循环：非妊娠
妊娠
急性发作稳定后的双相 I 型：非妊娠（包括快速循环和混合特征）
急性发作稳定后的双相 II 型：非妊娠
急性发作稳定后：妊娠
撰稿人
作者
Sudhakar Selvaraj, MBBS DPhil MRCPsych
Assistant Professor of Psychiatry
University of Texas Health Science Center
Houston
TX
利益声明
SS has received speaking honoraria from Global Medical Education and honoraria from the British Medical Journal Publishing Group. He owns convertible shares at Flow MedTech, Inc (a medical device start-up company). He has been involved in a treatment-resistant depression clinical trial and received research support from COMPASS pathways (a mental healthcare company).
鸣谢
Dr Sudhakar Selvaraj would like to gratefully acknowledge Dr Prashant Gajwani and Dr David J. Muzina, previous contributors to this topic.
利益声明
PG has served on the speakers' bureau for Merck and Sunovion. DJM is an author of a number of references cited in this topic. DJM has previously received honoraria for research support from Repligen Co. He has also previously received honoraria as a speaker and/or advisor from AstraZeneca, Pfizer, BMS, Wyeth, Sepracor, and GSK. DJM is a full-time employee of Medco.
同行评议者
Roger McIntyre, MD
Head
Mood Disorders Psychopharmacology Unit
University Health Network
Associate Professor of Psychiatry and Pharmacology
University of Toronto
Ontario
Canada
利益声明
RM has received research funds from Stanley Medical Research Institute and National Alliance for Research on Schizophrenia and Depression (NARSAD). RM is on the advisory boards for AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Organon, Lundbeck, Biovail, Pfizer, Shire, and Schering-Plough. RM is on the speakers' bureau for Janssen-Ortho, AstraZeneca, Eli Lilly, Lundbeck, Biovail, and Wyeth. RM has received research grants from Eli Lilly, Janssen-Ortho, and Shire.
Jan Scott, MBBS
Professor of Psychological Medicine
University of Newcastle
Honorary Professor
Psychological Treatments Research
Institute of Psychiatry
London
University Department of Psychiatry
Royal Victoria Infirmary
Newcastle upon Tyne
UK
利益声明
JS has received remuneration for attending advisory boards for AstraZeneca, BSM-Otsuka, Eli Lilly, GSK, and Sanofi-Aventis.
鉴别诊断
- 由一般躯体疾病引起的心境障碍
- 物质诱发的心境障碍
- 重性抑郁障碍 (MDD)
更多 鉴别诊断指南
- 双相情感障碍：评估和管理
- 世界生物精神病学会联合会 (World Federation of Societies of Biological Psychiatry, WFSBP) 双向情感障碍生物治疗指南：关于双向情感障碍混合状态的长期治疗和急性期治疗
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