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1、精神病学精神病学Affective(mood)Disorders XIE Guang-rong M.D.Definition Affectivedisordersarecharacterizedbyobviousandpersistentelationordepressionofmood.Themooddisturbanceiscommonlyassociatedwithcognitiveandbehavioralchanges.Inseverecases,psychoticsymptoms,suchashallucinationanddelusion,maybeobserved.Therei
2、sarecurrenttendency.Incertaincases,anepisodemaybecomechronicandresidualsymptomsareobserved.TheClassificationofAffectiveDisorders Manic episode (mania) Depression single episode (unipolar) recurrent episode With or Affective without Disorders Bipolar-I(with mania) Psychotic Bipolar Bipolar-II(with hy
3、pomania) symptom disorders Mixed type Rapid-cyclingbipolar disorder Dysthymia Cyclothymia disorder ClinicaldescriptionofmooddisordersTheepisodeSeverityMild,moderate,orsevereTypeDepressive,manic,mixedSpecialfeaturesWithmelancholicsymptomsWithneuroticsymptomsWithpsychoticsymptomsWithagitationWithretar
4、dationorstuporThecourseUnipolarorbipolarAetiologyPredominantlyreactivePredominantlyendogenousEtiologyGeneticCausesFamilyStudies:InastudyattheNationalInstituteofMentalHealth,25%ofrelativesofbipolarprobandswerefoundtohavebipolardisorderorunipolarillness(depression)themselves,comparedto20%ofrelativesof
5、unipolarprobandsand7%ofrelativesofcontrolsubjects.Somedatahavesupportedmultifactorialmodels,Thesemodelsimplymultiplefactors:genetic,environmental,orboth.Analternativeexplanationisheterogeneity.Inotherwords,singlemajorgenesareimportantinatleastsomefamilies,butitisnotthesamegeneineachfamily.Twinstudie
6、s:Onaverage,MZtwinpairsshowconcordance65%ofthetime,andDZtwinpairsshowconcordance14%ofthetime.AdoptionStudies:Inonestudy,theriskforaffectivedisorderinthebiologicalrelativesofbipolarprobandswas31%asopposedto2%intherelativesofcontrolprobands.Theriskinbiologicalrelativesofadoptedbipolarprobandswassimila
7、rtotheriskinrelativesofbipolarprobandswhowerenotadoptedaway(26%).Adoptiverelativesdidnotshowincreasedrisk.Adoptionstudiesthatusedabroaderclassofaffectiveprobandsshowedevidenceforgeneticfactorsbutalsopossibleenvironmentalinfluences.Molecular GeneticsLinkageStudiesChromosomalLocationReference18pBerret
8、tinietal19Stineetal199521qStraubetal1994Detera-Wadleighetal1996Xq26Pekkarinenetal199511p15Egelandetal1987Kelsoeetal1991Gurlingetal19955qCoonetal19934pBlackwoodetal199618qFreimeretal1996Stineetal1995Other(including10p,12q)Craddocketal1994Ewaldetal1995Ginnsetal1996NIMHGeneticsInitiative1997Summaryn Th
9、e lifetime risk for severe affective disorder is about 8%. Risk is increased to about 20% in first-degree relatives of unipolar patients and to 25% in first-degree relatives of bipolar patients. Risk appears to be 40% in relatives of schizoaffective patients. The risk to offspring of two affectively
10、 ill parents is more than 50%. Overall risk figures appear to be rising in recent years.Biological theoriesNeurotransmitters.We now know that all clinically effectiveantidepressantsincreaseneurotransmitterconcentrationsatpostsynapticreceptorsitesbyinhibitingtheirreuptake(intothepresynapticneuron)fro
11、mthesynapticcleft,Thisactionhasledtothehypothesisthatdepressioniscausedby a neurotransmitter deficiency and thatantidepressants exert their clinical effect bytreatingthisimbalance.Theserotonin-norepinephrine-gluco-corticoidlinkhypothesisofaffectivedisorders.Neuroendocrine factors.Thetwoendocrinesyst
12、emsmostextensivelystudiedinpsychiatryarethehypothalamic-pituitary-adrenal(HPA)axisandthehypothalamic-pituitary-thyroid(HPT)axis.Abouthalfofpatientswithmajordepressionexhibitcortisolhypersecretionthatreturnstonormaloncethedepressioniscured.Life events Recent evidence confirms that crucial life events
13、, particularly the death of loss of a loved one , can precede the onset of depression. However, such losses precede only a small number of cases of depression.Fewer than 20% of individuals experiencing losses become clinically depressed . These observations argue strongly for a predisposing factor,
14、possibly genetic , psychosocial,or characterological in nature. DepressiveepisodeDefinitionThedisorderischaracterizedbydepressedmoodthatisoutofkeepingwiththecircumstances.Itmayvaryfromlowmoodtomelancholia,orevenstupor.Inseverecases,psychoticsymptoms,suchasdelusionsandhallucinations,maybepresent.Epid
15、emiologySymptomsanddisordersofthedepressionspectrumarerathercommon.Lifetimeprevalenceratesfordepressivesymptomsare13%20%andformajordepressivedisorder3.7%6.7%.Majordepressivedisorderisabouttwotothreetimesascommoninadolescentandadultfemalesasinadolescentandadultmales.Inprepubertalchildren,boysandgirls
16、areaffectedequally.Ratesinwomenandmenarehighestinthe25-to44-year-oldagegroup.Signs & SymptomsMajor depressive episode Thecardinalfeatureofamajordepressiveepisodeisadepressedmoodorthelossofinterestorpleasurethatpredominatesforatleast2weeksandcausessignificantdistressorimpairmentintheindividualssocial,occupational,orotherimportantareasoffunctioning.1. Depressed mood.Depressedmoodisthemostcharacteristicsymptom,occurringinover90%ofpatients.Thepatientusuallydescribeshimselforherselfasfeelingsad,low,e
