双相障碍诊治方法与临床病例分享.ppt

* Risks of Misdiagnosis in Bipolar Disorder The risk is high without a diagnosis or an incorrect diagnosis due to incorrect or nonexistent therapy. Suicide rates among those with bipolar disorder average 0.4% per year. This value is more than 20-fold higher than that observed in the general population. Bipolar patients with a history of suicide attempts are the population at highest risk for suicidal behavior. The course of the disease is a risk factor with those with major depressive episode patterns, rapid cycling, and mixed episodes at highest risk. Race (Caucasians), age (adolescents and the elderly), and marital status (unmarried, especially without dependents) are other risk factors. * The response to treatment can also provide clues to the differentiation of unipolar and bipolar. In contrast to unipolar depression, treatment response to bipolar disease is characterized by an abrupt onset of antidepressant effect, an early loss of response, and increased agitation/mixed state. Personal Communication: RH Perlis, MD. Ghaemi SN, Lenox MS, Baldessarini RJ. Effectiveness and safety of long-term antidepressant treatment in bipolar disorder. J Clin Psychiatry. 2001;62:565-569. Nierenberg AA, Feinstein AR. How to evaluate a diagnostic marker test. Lessons from the rise and fall of dexamethasone suppression test. JAMA. 1998;259:1699-1702. * Unipolar vs Bipolar Depression There is no consistent and reliable difference in depressive symptomatology between bipolar disorder and unipolar depressed patients. However, patients with unipolar depression are more likely to have anxiety symptoms and somatic complaints. Patients with bipolar depression are much more likely to have fatigue, increased need for sleep (often with difficulty getting up in the morning), and substantial psychomotor retardation. Bowden CL. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord. 2005;84:117-125. Mitchell PB, Wilhelm K, Parker G,