Sierra Pilar, Livianos Lorenzo, Arques Sergio, Castelló Javier, Rojo Luis
Psychiatric Unit, Hospital La Fe, Valencia 46009, Spain.
Aust N Z J Psychiatry. 2007 May;41(5):385-91. doi: 10.1080/00048670701266854.
In a cyclical and recurring illness such as bipolar disorder, prodrome detection is of vital importance. This paper describes manic and depressive prodromal symptoms to relapse, methods used in their detection, problems inherent in their assessment, and patients' coping strategies. A review of the literature on the issue was performed using MEDLINE and EMBASE databases (1965-May 2006). 'Bipolar disorder', 'prodromes', 'early symptoms', 'coping', 'manic' and 'depression' were entered as key words. A hand search was conducted simultaneously and the references of the articles found were used to locate additional articles. The most common depressive prodromes are mood changes, psychomotor symptoms and increased anxiety; the most frequent manic prodromes are sleep disturbances, psychotic symptoms and mood changes. The manic prodromes also last longer. Certain psychological interventions, both at the individual and psychoeducational group level, have proven effective, especially in preventing manic episodes. Bipolar patients are highly capable of detecting prodromal symptoms to relapse, although they do find the depressive ones harder to identify. Learning detection, coping strategies and idiosyncratic prodromes are elements that should be incorporated into daily clinical practice with bipolar patients.
在双相情感障碍这种周期性复发的疾病中，前驱症状的检测至关重要。本文描述了躁狂和抑郁复发的前驱症状、检测这些症状所采用的方法、评估中存在的固有问题以及患者的应对策略。利用MEDLINE和EMBASE数据库（1965年至2006年5月）对该问题的文献进行了综述。以“双相情感障碍”、“前驱症状”、“早期症状”、“应对”、“躁狂”和“抑郁”作为关键词进行检索。同时进行了手工检索，并利用所找到文章的参考文献来查找更多文章。最常见的抑郁前驱症状是情绪变化、精神运动症状和焦虑增加；最常见的躁狂前驱症状是睡眠障碍、精神病症状和情绪变化。躁狂前驱症状持续的时间也更长。某些个体层面和心理教育小组层面的心理干预已被证明是有效的，尤其是在预防躁狂发作方面。双相情感障碍患者有很强的能力检测复发的前驱症状，尽管他们确实发现抑郁前驱症状更难识别。学习检测方法、应对策略和个体特有的前驱症状是应该纳入双相情感障碍患者日常临床实践中的要素。
