Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Suite E4.400, Houston, TX 77030, USA; Mental Health Care Line, Michael E. DeBakey VAMC, 2002 East Holcombe Boulevard, Houston, TX 77030, USA.
Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Suite E4.400, Houston, TX 77030, USA.
Psychiatr Clin North Am. 2020 Mar;43(1):153-165. doi: 10.1016/j.psc.2019.10.005. Epub 2019 Nov 28.
Susceptibility to combined depressive and manic syndromes correlates strongly with arousal-related symptoms including impulsivity, anxiety and agitation. This relationship to a driven, "mixed" activation-depression state, generated by a life-long process, was described in classical times. Course of illness in mixed states includes increased episode frequency, duration, earlier onset, and association with addiction- and trauma/stress-related disorders. Mixed episodes have catecholamine and hypothalamic-pituitary-adrenocortical activity increased beyond nonmixed states of similar symptom severity. These properties resemble behavioral sensitization, where salient, survival-related stimuli (traumatic or rewarding) can generate persistently exaggerated responses with disrupted arousal and reward, with potential for suicide and other severe consequences.
对抑郁和躁狂综合征的易感性与与唤醒相关的症状密切相关，包括冲动、焦虑和激越。这种与驱动性、“混合”激活-抑郁状态的关系，是由一个终身过程产生的，在古典时期就有描述。混合状态的病程包括发作频率增加、持续时间延长、发病时间更早，以及与成瘾和创伤/应激相关障碍有关。混合发作的儿茶酚胺和下丘脑-垂体-肾上腺皮质活性高于相似严重程度的非混合状态。这些特性类似于行为敏感化，其中显著的、与生存相关的刺激（创伤性或奖励性）可以产生持续夸大的反应，导致唤醒和奖励功能障碍，有自杀和其他严重后果的风险。
