小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 悲伤和/或易激惹情绪
- 兴趣减少或缺乏乐趣
- 严重的功能缺损
- 无躁狂或轻躁狂发病证据
- 无最近的伤恸病史
其他诊断因素
- 注意力降低或犹豫不决
- 失眠或睡眠过度
- 食欲或体重变化
- 过度疲乏
- 无价值感或过度内疚
- 感到绝望
- 精神运动性激越或迟滞
- 躯体主诉
- 社交回避或朋友变化
- 反复出现死亡想法或自杀意念及自我伤害
- 增加的物质使用
危险因素
- 抑郁症的阳性家族史
- 其他父母精神病变
- 其他精神疾病（例如，焦虑障碍）的个人病史
- 应激或外伤
- 女性
- 性别少数状态
- 慢性内科疾病的个人病史
- 出生后状态
- 邻里和社会不稳定
- 免疫抑制药物（例如，皮质类固醇、干扰素）
- 物质使用/滥用
诊断性检查
首要检查
- 临床诊断
需考虑的检查
- 血清促甲状腺激素 (TSH) 和游离甲状腺素 (T4)
- 全血细胞计数及分类
- 尿液药物筛查
- 尿液妊娠试验
- 血清维生素 B12 和叶酸
- 维生素 D 水平
治疗流程
存在自我伤害风险
轻度
中度或重度
急性症状稳定之后
撰稿人
作者
Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)
Conjoint Professor of Child and Adolescent Psychiatry
Specialty of Psychiatry, School of Medicine
University of Sydney
Sydney
Australia
利益声明
PH declares that he has no competing interests.
Khrista Boylan, MD, PhD, FRCPC
Associate Professor
Psychiatry and Behavioural Neurosciences
McMaster University
Hamilton
Canada
利益声明
KB declares that she has no competing interests.
鸣谢
Professor Philip Hazell and Dr Khrista Boylan would like to gratefully acknowledge Dr Lisa Pan, Dr David A. Brent, Dr Rongrong Tao, Dr Graham Emslie, and Dr Taryn Mayes, the previous contributors to this topic.
利益声明
LP declares that she has no competing interests. DAB receives royalties from Guilford Press; has received or will receive royalties from the electronic self-rated version of the C-SSRS from ERT, Inc; is on the editorial board of UpToDate; is a reviewer for Healthwise; and is on the board of the Klingenstein Foundation. RT is an author of a number of references cited in this topic. GE has received research funds from BioMarin, Eli Lilly, Forest Laboratories, GlaxoSmithKline, and Somerset; has served as a consultant for Biobehavioral Diagnostic Company, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, INC Research Inc., Lundbeck, Pfizer Inc., Seaside Therapeutics, Shire Pharmaceuticals, Valeant, Validus Pharmaceuticals, and Wyeth Ayerst; and has been on the speaker's bureau for Forest Laboratories. TM is an author of a number of references cited in this topic.
同行评议者
Richa Bhatia, MD
Director of Psychiatry
Santa Rosa Community Health
CA
利益声明
RB declares that he has no competing interests.
Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, MD
Honorary Senior Lecturer
Institute of Child Health and Institute of Psychiatry
Consultant in Child and Adolescent Neuropsychiatry and Psychopharmacology
Head of Centre for Interventional Paediatric Psychopharmacology
Department of Child & Adolescent Mental Health
Great Ormond Street Hospital for Children
London
UK
利益声明
PJS declares that he has no competing interests.
Pieter Joost van Wattum, MD, MA
Assistant Clinical Professor of Child Psychiatry
Yale School of Medicine
Medical Director of Psychiatry
Clifford W. Beers Guidance Clinic
New Haven
CT
利益声明
PJvW declares that he has no competing interests.
鉴别诊断
- 双相障碍
- 焦虑障碍
- ADHD
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