Department of Health Sciences, University of Florence, Florence, Italy.
Psychother Psychosom. 2015;84(1):22-9. doi: 10.1159/000367913. Epub 2014 Dec 24.
Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis.
MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed.
A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent.
Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.
涉及情绪、焦虑和易怒改变的情感障碍可能是医学疾病的早期症状。本文的目的是提供一个系统的文献综述，采用定性数据综合方法。
从建库开始至 2014 年 2 月，我们系统性地检索了 MEDLINE、PsycINFO、EMBASE、Cochrane 以及 ISI Web of Science 数据库。检索词为“前驱期/早期症状”，使用布尔运算符“AND”与“焦虑/抑郁/躁狂/轻躁狂/易怒/易激惹/敌意”相结合，再使用布尔运算符“AND”与“医学疾病/医学紊乱”相结合。我们遵循 PRISMA 指南。
共有 21 项研究符合纳入标准并进行了分析。抑郁是最常见的医学疾病的情感前驱症状，在库欣综合征、甲状腺功能减退症、甲状旁腺功能亢进症、胰腺和肺癌、心肌梗死、威尔逊病和艾滋病中均有报道。躁狂、焦虑和易怒则相对少见。
医生可能不会对看似精神疾病的病例进行医学检查。他们应该注意到，情绪、焦虑和易怒的障碍可能会先于医学疾病的出现。
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