Rakofsky Jeffrey, Rapaport Mark
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):804-827. doi: 10.1212/CON.0000000000000604.
This article discusses the prevalence of the major mood disorders (major depressive disorder and bipolar disorder) in the community and within neurologic settings, articulates the steps taken to make a diagnosis of major depressive disorder or bipolar disorder, and reviews old and newer treatment options with proven efficacy for the treatment of these two conditions.
New medications are available as treatment options for major depressive disorder and bipolar disorder, such as intranasal and IV ketamine, and somatic treatments, such as deep brain stimulation and vagal nerve stimulators, are being used to target treatment-resistant depression.
Mood disorders are common in neurologic settings. They are disabling and increase morbidity and mortality. Clinicians should have a high index of suspicion if they suspect their patients seem more distressed or incapacitated than would be warranted by their neurologic disorders. If a patient does have a mood disorder, validating the patient's experience, initiating treatment, and, if necessary, referring the patient to a primary care physician or psychiatrist are appropriate steps.
本文讨论了社区及神经科环境中主要心境障碍(重度抑郁症和双相情感障碍)的患病率,阐述了诊断重度抑郁症或双相情感障碍的步骤,并回顾了已证实对这两种疾病有效的新旧治疗方案。
有新的药物可作为重度抑郁症和双相情感障碍的治疗选择,如鼻内和静脉注射氯胺酮,并且正在使用一些躯体治疗方法,如深部脑刺激和迷走神经刺激器,来治疗难治性抑郁症。
心境障碍在神经科环境中很常见。它们会导致残疾,并增加发病率和死亡率。如果临床医生怀疑患者看起来比其神经系统疾病应有的情况更痛苦或丧失能力,就应该高度怀疑。如果患者确实患有心境障碍,确认患者的经历、开始治疗,并在必要时将患者转诊给初级保健医生或精神科医生是合适的步骤。