躁狂
此條目需要擴充。 (2017年5月14日) |
躁狂(发作) | |
---|---|
类型 | 心境障碍 |
治療 | 心理治療 |
分类和外部资源 | |
醫學專科 | 精神病学 |
ICD-10 | F31.1, F30 |
ICD-9-CM | 296.0 Single manic episode, 296.4 Most recent episode manic, 296.6 Most recent episode mixed |
MeSH | D001714 |
躁狂(英語:mania),又称躁狂发作,台湾又称狂躁[1],中国大陆又称躁狂症[2],是一种以明显而持久的心境高涨为主的情感性精神障碍,也属于双相情感障碍的一种发作形式,典型症状为情感高涨、思维奔逸和活动增多等,部分患者同时伴有认知功能损害。[2][3][4][5]发作期间,患者情绪极不稳定,易受环境刺激影响。躁狂通常会认为是抑郁的反义词,但事实上,躁狂的情感高涨除了表现为欣快感的高涨,也可以表现为极其易怒,并且随着症状的发展,患者会更加易怒,同时可能会因此导致焦虑症并使患者更容易产生暴力行为。[6]
躁狂不一定意味着情感性精神障碍,同抑郁相似,躁狂可以是短期或长期的情绪状态,仅有符合一定条件时,才可以认定为情感性精神障碍。[7]
病因
[编辑]躁狂的成因尚不明确,可能受到遗传、心理、生理、滥用药品和社会环境等多方面影响。[8][9]
有研究指出,体内谷氨酸盐含量失调和滥用氯胺酮所导致的NMDA受体失调[10][11][12]以及miRNA功能部分受损可能是躁狂发作的诱因。[13] 同时,也有研究发现,同正常人相比,躁狂患者大脑的杏仁核、海马体、基底神经节、前额叶皮层和前扣带皮层等部分有异常反应,其中前额叶皮质、额下回眶部等部分活跃程度较低,而岛叶部分活跃程度较高。[14][15][16]
部分抗抑郁药(如SSRI类药品)和毒品也有导致和加剧躁狂的风险。酗酒也是导致躁狂的重要原因之一。[17]
有研究者指出,躁狂患者体内多巴胺转运蛋白密度相较于正常人较低,而体内多巴胺含量过多,进而推测体内多巴胺含量过多或体内多巴胺回收功能减弱可能会引起躁狂发作,并且多巴胺转运蛋白密度和多巴胺含量同躁狂症状的严重程度相关。[18]也有实验表明,躁狂发作可能和患者压力长期过大有关。[19]
诊断
[编辑]诊断躁狂通常依据DSM-5标准,同时可能通过量表和脑电图检查等检查方式辅助诊断。然而需要注意的是,有许多疾病发病时的表现同躁狂相似,因而在诊断躁狂时应当排除其他疾病引发的可能。其中,同躁狂发作最为相似的是兴奋剂、致幻剂或吸食毒品中毒。
预防和治疗
[编辑]预防
[编辑]治疗
[编辑]躁狂的治疗应当尽可能的采用联合治疗的方法,在特殊情况下,应当考虑接受住院治疗。[20]
有研究和病例表明,针对急性躁狂发作,可以采用碳酸锂[21]、卡马西平、氯氮平等抗惊厥药、抗精神病药品进行治疗。而后经由医生诊断,可以继续使用上述药品或考虑使用其他适合的药品进行长期治疗。[22]
除了通过药物治疗外,在实践中也常用电休克疗法治疗躁狂。[23][24]有案例表明,心理咨询以及加强患者家属心理知识的辅导尽管不能够作为单一治疗方式[25],但也可以起到一定缓解病情的作用。[26][27]
外部链接
[编辑]參見
[编辑]参考资料
[编辑]- ^ mania. 樂詞網. 國家教育研究院. (繁體中文)
- ^ 2.0 2.1 mania. 术语在线. 全国科学技术名词审定委员会. (简体中文)
- ^ 尹彬华. 探讨躁狂症的临床诊治措施及效果. 国际医药卫生导报. 2013. doi:10.3760/cma.j.issn.1007-1245.2013.17.034 –通过中华医学期刊.
- ^ Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin, Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Misès, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.; Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter, C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.; Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West, D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman, P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J. The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines (PDF). www.who.int World Health Organization: 30. [3 July 2021]. (原始内容存档 (PDF)于17 October 2004).
- ^ 刘胜超; 侯瑞. 无抽搐电休克联合碳酸锂、奥氮平对躁狂症患者临床疗效、躁狂症状、精神状态、认知功能、神经功能的影响. 黑龙江医药科学. 2024, 47 (5): 90 –通过知网. CNKI KXJY202405030.
- ^ Dysphoric mania: Symptoms, facts, and treatment. 29 November 2018 [10 October 2020]. (原始内容存档于1 November 2020).
- ^ Kotzalidis, Georgios; Rapinesi, Chiara; Savoja, Valeria; Cuomo, Ilaria; Simonetti, Alessio; Ambrosi, Elisa; Panaccione, Isabella; Gubbini, Silvia; Rossi, Pietro; Chiara, Lavinia; Janiri, Delfina. Neurobiological Evidence for the Primacy of Mania Hypothesis. Current Neuropharmacology. 2017-02-28, 15 (3). PMC 5405607 . PMID 28503105. doi:10.2174/1570159X14666160708231216 (英语).
- ^ Kugaya, Akira; Sanacora, Gerard. Beyond Monoamines: Glutamatergic Function in Mood Disorders. CNS Spectrums. 2005-10, 10 (10). ISSN 1092-8529. doi:10.1017/S1092852900010403 (英语).
- ^ Koyuncu, Ahmet; İnce, Ezgi; Ertekin, Erhan; Tükel, Raşit. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs in Context. 2019-04-02, 8. PMC 6448478 . PMID 30988687. doi:10.7573/dic.212573.
- ^ Mathew, Sanjay J; Manji, Husseini K; Charney, Dennis S. Novel Drugs and Therapeutic Targets for Severe Mood Disorders. Neuropsychopharmacology. 2008-08, 33 (9). ISSN 0893-133X. doi:10.1038/sj.npp.1301652 (英语).
- ^ Serafini, Gianluca; Pompili, Maurizio; Innamorati, Marco; Dwivedi, Yogesh; Brahmachari, Goutam; Girardi, Paolo. Pharmacological Properties of Glutamatergic Drugs Targeting NMDA Receptors and their Application in Major Depression. Current Pharmaceutical Design. 2013-01-18, 19 (10). ISSN 1381-6128. doi:10.2174/13816128113199990293.
- ^ Lane, Hsien-Yuan; Lu, Yuan-Yuan; Lin, Chieh-Hsin. Mania following ketamine abuse. Neuropsychiatric Disease and Treatment. 2016-01. ISSN 1178-2021. PMC 4737325 . PMID 26869791. doi:10.2147/NDT.S97696 (英语).
- ^ Serafini, Gianluca; Pompili, Maurizio; Innamorati, Marco; Giordano, Gloria; Montebovi, Franco; Sher, Leo; Dwivedi, Yogesh; Girardi, Paolo. The role of microRNAs in synaptic plasticity, major affective disorders and suicidal behavior. Neuroscience Research. 2012-07, 73 (3). doi:10.1016/j.neures.2012.04.001 (英语).
- ^ Hajek, Tomas; Alda, Martin; Hajek, Eva; Ivanoff, Jason. Functional neuroanatomy of response inhibition in bipolar disorders – Combined voxel based and cognitive performance meta-analysis. Journal of Psychiatric Research. 2013-12, 47 (12). doi:10.1016/j.jpsychires.2013.08.015 (英语).
- ^ Chen, Chi-Hua; Suckling, John; Lennox, Belinda R; Ooi, Cinly; Bullmore, Ed T. A quantitative meta-analysis of fMRI studies in bipolar disorder: Meta-analysis of fMRI studies in BD. Bipolar Disorders. 2011-02, 13 (1). doi:10.1111/j.1399-5618.2011.00893.x (英语).
- ^ Cotovio, Gonçalo; Oliveira-Maia, Albino J. Functional neuroanatomy of mania. Translational Psychiatry. 2022-01-24, 12 (1). ISSN 2158-3188. PMC 8786958 . PMID 35075120. doi:10.1038/s41398-022-01786-4 (英语).
- ^ Coryell, William. 双相情感障碍的病因. 默沙东诊疗手册. [2024-09-28]. (原始内容存档于2024-03-06) (中文).
- ^ Discovering the likely cause of manic symptoms in bipolar disorders. VCHRI. [2024-09-29] (英语). 已忽略文本“ VCH Research Institute ” (帮助)
- ^ Li, Xinyu; Chen, Binjie; Zhang, Dianjun; Wang, Siman; Feng, Yuliang; Wu, Xiafang; Cui, Lulu; Ji, Ming; Gong, Wenliang; Verkhratsky, Alexei; Xia, Maosheng. A novel murine model of mania. Molecular Psychiatry. 2023-07, 28 (7). ISSN 1359-4184. PMC 10615760 . PMID 36991130. doi:10.1038/s41380-023-02037-8 (英语).
- ^ Vieta, Eduard; Sanchez-Moreno, Jose. Acute and long-term treatment of mania. Dialogues in Clinical Neuroscience. 2008-06-30, 10 (2). ISSN 1958-5969. PMC 3181868 . PMID 18689287. doi:10.31887/DCNS.2008.10.2/evieta (英语).
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