Fakra Eric, Belzeaux R, Azorin J M, Adida M
Pôle Universitaire de Psychiatrie, CHU Saint-Etienne. - 5 chemin de la Marendière.42055 St Etienne cedex 2, France.
SHU Psychiatrie adultes, Solaris, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France.
Encephale. 2014 Dec;40 Suppl 3:S46-50. doi: 10.1016/S0013-7006(14)70131-9.
Epidemiologic studies show a frequent co-occurence of affective and eating disorders. The incidence of one disorder in patients suffering from the other disorder is well over the incidence in the general population. Several causes could explain this increased comorbidity. First, the iatrogenic origin is detailed. Indeed, psychotropic drugs, and particularly mood stabilizers, often lead to modification in eating behaviors, generally inducing weight gain. These drugs can increase desire for food, reduce baseline metabolism or decrease motor activity. Also, affective and eating disorders share several characteristics in semiology. These similarities can not only obscure the differential diagnosis but may also attest of conjoint pathophysiological bases in the two conditions. However, genetic and biological findings so far are too sparse to corroborate this last hypothesis. Nonetheless, it is noteworthy that comorbidity of affective and eating disorders worsens patients'prognosis and is associated with more severe forms of affective disorders characterized by an earlier age of onset in the disease, higher number of mood episodes and a higher suicidality. Lastly, psychotropic drugs used in affective disorders (lithium, antiepileptic mood stabilizers, atypical antipsychotics, antidepressants) are reviewed in order to weigh their efficacy in eating disorders. This could help establish the best therapeutic option when confronted to comorbidity.
流行病学研究表明，情感障碍与饮食失调常常同时出现。患有另一种疾病的患者中一种疾病的发病率远高于普通人群中的发病率。有几个原因可以解释这种合并症增加的现象。首先，详细阐述了医源性病因。确实，精神药物，尤其是心境稳定剂，常常会导致饮食行为的改变，通常会引起体重增加。这些药物会增加食欲、降低基础代谢率或减少运动活动。此外，情感障碍和饮食失调在症状学上有几个共同特征。这些相似之处不仅会模糊鉴别诊断，还可能证明这两种情况存在共同的病理生理基础。然而，迄今为止，遗传学和生物学研究结果过于稀少，无法证实这一最后的假设。尽管如此，值得注意的是，情感障碍和饮食失调的合并症会恶化患者的预后，并与更严重形式的情感障碍相关，其特征为疾病发病年龄更早、情绪发作次数更多以及自杀倾向更高。最后，对用于情感障碍的精神药物（锂盐、抗癫痫心境稳定剂、非典型抗精神病药物、抗抑郁药）进行了综述，以权衡它们在饮食失调中的疗效。这有助于在面对合并症时确定最佳治疗方案。
