Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Victoria, Australia.
Nat Rev Dis Primers. 2018 Mar 8;4:18008. doi: 10.1038/nrdp.2018.8.
Bipolar disorders are chronic and recurrent disorders that affect >1% of the global population. Bipolar disorders are leading causes of disability in young people as they can lead to cognitive and functional impairment and increased mortality, particularly from suicide and cardiovascular disease. Psychiatric and nonpsychiatric medical comorbidities are common in patients and might also contribute to increased mortality. Bipolar disorders are some of the most heritable psychiatric disorders, although a model with gene-environment interactions is believed to best explain the aetiology. Early and accurate diagnosis is difficult in clinical practice as the onset of bipolar disorder is commonly characterized by nonspecific symptoms, mood lability or a depressive episode, which can be similar in presentation to unipolar depression. Moreover, patients and their families do not always understand the significance of their symptoms, especially with hypomanic or manic symptoms. As specific biomarkers for bipolar disorders are not yet available, careful clinical assessment remains the cornerstone of diagnosis. The detection of hypomanic symptoms and longtudinal clinical assessment are crucial to differentiate a bipolar disorder from other conditions. Optimal early treatment of patients with evidence-based medication (typically mood stabilizers and antipsychotics) and psychosocial strategies is necessary.
双相情感障碍是一种慢性、复发性疾病,影响全球超过 1%的人口。双相情感障碍是导致年轻人残疾的主要原因,因为它会导致认知和功能障碍,并增加死亡率,特别是自杀和心血管疾病的死亡率。精神科和非精神科的合并症在患者中很常见,也可能导致死亡率增加。双相情感障碍是最具遗传性的精神障碍之一,尽管人们认为基因-环境相互作用的模型最能解释其病因。由于双相情感障碍的发病通常以非特异性症状、情绪不稳定或抑郁发作为特征,与单相抑郁的表现相似,因此在临床实践中早期和准确的诊断很困难。此外,患者及其家属并不总是了解其症状的意义,尤其是轻躁狂或躁狂症状。由于目前还没有针对双相情感障碍的特异性生物标志物,因此仔细的临床评估仍然是诊断的基石。检测轻躁狂症状和纵向临床评估对于将双相情感障碍与其他疾病区分开来至关重要。对有证据支持的药物(通常是心境稳定剂和抗精神病药)和心理社会策略进行早期的最佳治疗是必要的。