Mury M, Verdoux H, Bourgeois M
Centre Carriere, Université de Bordeaux II.
Encephale. 1995 Sep-Oct;21(5):545-53.
The frequent association of bulimia nervosa and affective disorders is well documented. Most studies on this topic have focused on the comorbidity of bulimia nervosa and unipolar depression. The literature on the comorbidity of eating disorders and bipolar disorder is more sparse. Nevertheless, an increased rate of bipolar disorder, especially bipolar II disorder, has been found by several epidemiological studies in patients with bulimia nervosa. This association might be more frequent in bulimic patients presenting with a severe chronic type of eating disorder. The relatives of bulimic patients also display an increased morbid risk for bipolar disorder. Although the comorbidity of bulimia and bipolar disorder does not appear coincidental, the nosological relationships between these two disorders are not perfectly clear. The possible relationships between seasonal affective disorders and bulimia nervosa have recently been suggested by some epidemiological studies, demonstrating that bulimia may display seasonal variations with winter worsening of bulimic symptoms. Eating symptoms are present in both winter depression and bulimia nervosa. The carbohydrate craving encountered in the former disorder could be compared to "binge eating" in bulimic patients. Epidemiological data suggest that winter depression is most frequently part of a bipolar II disorder. Few data are available concerning the therapeutic implications of the association of bulimia nervosa and bipolar disorder. Some case reports of concomitant remission of both disorders with anticonvulsivants or lithium salts have been published. However, there are no controlled studies. Anticonvulsivants or lithium salts might be indicated in some bulimic patients who do not present with a typical bipolar disorder, but who fulfill clinical criteria which are potentially predictive of a good response to such medications.
神经性贪食症与情感障碍的频繁关联已有充分记录。关于这一主题的大多数研究都集中在神经性贪食症与单相抑郁症的共病情况。关于饮食失调与双相情感障碍共病的文献则较为稀少。尽管如此，多项流行病学研究在神经性贪食症患者中发现双相情感障碍的发病率有所增加，尤其是双相II型障碍。这种关联在患有严重慢性饮食失调类型的贪食症患者中可能更为常见。贪食症患者的亲属患双相情感障碍的患病风险也有所增加。虽然贪食症和双相情感障碍的共病并非偶然，但这两种障碍之间的疾病分类关系尚不完全清楚。一些流行病学研究最近提出了季节性情感障碍与神经性贪食症之间可能的关系，表明贪食症可能呈现季节性变化，冬季时贪食症状会加重。冬季抑郁症和神经性贪食症都存在饮食症状。前一种疾病中出现的对碳水化合物的渴望可与贪食症患者的“暴饮暴食”相比较。流行病学数据表明，冬季抑郁症最常是双相II型障碍的一部分。关于神经性贪食症与双相情感障碍关联的治疗意义，可用的数据很少。已经发表了一些关于使用抗惊厥药或锂盐使两种障碍同时缓解的病例报告。然而，尚无对照研究。对于一些不表现出典型双相情感障碍，但符合可能预测对这类药物有良好反应的临床标准的贪食症患者，可能需要使用抗惊厥药或锂盐。
