双相障碍-分裂情感障碍-分裂症鉴别的生物学边界.ppt

Informing DSM-5：Biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia Victoria E Cosgrove and Trisha Suppes BMC Medicine 2013, 11:128 Figure 1. DSM-IV-TR features of bipolar I disorder, schizoaffective disorder, and schizophrenia. Table 1 .Summary of key evidence at the forefront of the boundaries of schizophrenia, schizoaffective disorder, andbipolar I disorder debate Table 2. Strength of evidence for biological factors supporting merging in some way schizophrenia, schizoaffective and bipolar I disorder A hundred years ago, Kraepelin distinguished two types of “insanity” in his institutionalized patients: dementia praecox (later relabeled as schizophrenia) and manic-depressive illness （later relabeled as bipolar disorder）. His dichotomy was based on differences in clinical features, course, and outcomes. But over the years, Kraepelin recognized and admitted that some patients have overlapping features, and he gradually accepted what is now seen as a continuum of psychosis that “bridges”（ schizoaffective disorder） the pure forms of those two disorders. Symptoms. Beyond a doubt, these two brain diseases have overlapping clinical features, pharmacotherapies,and even outcomes in a subgroup of patients. However, these diseases have major differences, as outlined in the accompanying table (page 68). Brain anomalies. Neuroimaging studies indicate that schizophrenia is associated with more-severe and pervasive morphologic brain anomalies (dysplasia and hypoplasia) than bipolar disorder, although some bipolar patients have reduced cerebral and frontal volumes and marked cognitive deficits.3 Progressive neuro tissue loss has been observed early in schizophrenia but not in bipolar disorder. 3. Coffman JA, Bornstein RA, Olson SC, et al. Cognitive impairment and cerebral structure by MRI in bipolar disorder. Biol Psychiatry 1990;27(11):1188-96. Recent genetic studies indicate that several genes are found exclusively in schizophr