双相抑郁障碍__培训课件.ppt

* 情感障碍问卷调查表 情感障碍调查问卷表（MDQ）为由一组精神病学家、研究者以及消费者倡导者研发的具有13项条款的一个目录。 MDQ是设计用来帮您判定您的患者可能发生了何种类型的情感障碍。 MDQ帮助您筛查可嫩的双相情感障碍的症状。一个病人完成这份调查问卷需要大约5分钟。 CANMAT双相情感障碍指南推荐对于支持两个或者更多个症状的患者，应该对其进行躁狂或者轻躁狂的进一步的提问。然后应该根据 DSM-IV 标准作出诊断（Yatham LN, et al. Bipolar Disord. 2005;7[Suppl 3]:5-69）。 MDQ结合家族史问卷调查可能可以帮助您对患者进行评价。 * * * * * Increased Risk for Suicide Attempts With Delayed Mood Stabilizer Initiation Delayed initiation of mood stabilizers adversely affected outcomes in all domains, particularly suicide risk, regardless of an index episode polarity of mania or depression. Although many persons with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in men and women diagnosed with bipolar disorder is more than 20 times greater than in the general population. From another perspective, about half of all suicides can be attributed to bipolar disorder. Goldberg JF, Ernst, CL. Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatry. 2002;63:985-991. * * * There are a number of approaches to the treatment of bipolar depression. Lithium is first-line therapy for depression. There is some data demonstrating the effectiveness of typical antipsychotics and anticonvulsants for the treatment of depressive episodes. Antidepressants can be used as add-on therapy, but not monotherapy. Several older controlled trials have also demonstrated the effectiveness of ECT in bipolar depression. American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder. Am J Psychiatry. 2002;159(suppl):1-50. * All patients with bipolar I disorder should be receiving a mood stabilizer, prior to or concurrently with an antidepressant to minimize the risk of antidepressant-induced mania. Frances et al in 1998 published The Expert Consensus Guidelines for Treating Depression in Bipolar Disorder. They surveyed 61 leading clinical researchers by asking eight ques