Koukopoulos A, Koukopoulos A
Centro Lucio Bini, Rome, Italy.
Psychiatr Clin North Am. 1999 Sep;22(3):547-64. doi: 10.1016/s0193-953x(05)70095-2.
The extensive use of antidepressant drugs in the treatment of all forms of depression makes the question of the real nature of agitated depression a crucial issue because many patients have adverse outcomes, including increased agitation, increased insomnia, increased risk of suicide, and sometimes the onset of psychotic symptoms. Agitated depression is no longer considered a mixed state in the DSM system. After a review of the literature on melancholia agitata as a mixed state and on the introduction of the concept of mixed states, this article has examined the psychopathology of agitated depression. The main symptoms are depressive mood with marked anxiety, restlessness, and often delusions. In other cases, psychic agitation and racing or crowded thoughts prevail alongside anxiety and depressed mood. The mixed nature of these symptoms has been discussed and new diagnostic criteria proposed, including those syndromes without marked restlessness but with evident psychic agitation and racing or crowded thoughts. It is suggested that all the varieties of agitated depression be called mixed depression, with the following diagnostic criteria: A. Major depressive episode B. At least two of the following symptoms: 1. Motor agitation 2. Psychic agitation or intense inner tension 3. Racing or crowded thoughts.
抗抑郁药物在各种形式抑郁症治疗中的广泛应用，使得激越性抑郁的真正本质问题成为一个关键问题，因为许多患者会出现不良后果，包括激越加剧、失眠加重、自杀风险增加，有时还会出现精神病性症状。在《精神疾病诊断与统计手册》（DSM）系统中，激越性抑郁不再被视为一种混合状态。在回顾了关于激越性忧郁症作为一种混合状态的文献以及混合状态概念的引入后，本文研究了激越性抑郁的精神病理学。主要症状为伴有明显焦虑、坐立不安且常伴有妄想的抑郁情绪。在其他情况下，精神激越、思维奔逸或思维云集与焦虑和抑郁情绪同时存在。本文讨论了这些症状的混合性质，并提出了新的诊断标准，包括那些没有明显坐立不安但有明显精神激越、思维奔逸或思维云集的综合征。建议将所有类型的激越性抑郁都称为混合性抑郁，其诊断标准如下：A. 重度抑郁发作；B. 至少具备以下两种症状：1. 运动性激越；2. 精神激越或强烈的内心紧张感；3. 思维奔逸或思维云集。
