伴有緊張性癥狀的女性雙相情感障礙的臨床研究

吳國平　普建文　何萍

【摘要】 目的：探討伴緊張癥狀女性雙相情感障礙的臨床特點(diǎn)。方法：回顧性分析入院時(shí)伴緊張癥狀、出院時(shí)符合ICD-10的緊張型精神分裂癥（A組）與雙相情感障礙癥（B組）各30例患者的臨床資料。結(jié)果：A、B兩組患者病期分別為（37.9±17.7）d、（18.0±13.4）d；入院診斷符合率分別為93.3%、60.0%，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。臨床現(xiàn)象的比較：B組起病急，病前受應(yīng)激因素影響易輕躁狂，伴緊張癥狀時(shí)多呈“作態(tài)”、“裝相”戲劇化行為，治療1周內(nèi)可緩解且反應(yīng)敏感于A組。A組患者癥狀緩解后的BPRS評定顯示“激活性”因子、“焦慮憂郁”因子分值均明顯高于B組（P<0.05），B組患者癥狀緩解后的BPRS評定顯示“缺乏活力”因子，“敵對猜疑”因子，“思維障礙”因子分值均明顯高于A組（P<0.05）。結(jié)論：緊張性癥狀與精神分裂癥、雙相情感障礙有關(guān)，但兩者的起病形式、應(yīng)激影響、性格特點(diǎn)以及治療反應(yīng)性差異顯著，且癥狀緩解后A組的“缺乏活力”、“敵對猜疑”、“思維障礙”明顯區(qū)別于B組的興奮、焦慮等情緒化特點(diǎn)。

【關(guān)鍵詞】 緊張； 女性； 雙相情感障礙； 精神分裂癥

【Abstract】 Objective：To investigate the clinical characteristics of bipolar disorder in women with nervous symptoms.Method：The clinical data of 30 patients with nervous symptoms at the time of admission，at discharge in accordance with the ICD -10 nervous type schizophrenia（the group A） and 30 patients with bipolar disorder（the group B） were retrospectively analyzed.Result：The disease stage of group A and group B were （37.9±17.7）d，（18.0±13.4）d；

admission diagnosis coincidence rate were 93.3%，60.0% respectively，the differences were statistically significant（P<0.05）.The clinical phenomenon of comparison：the group B acute onset，before the disease affected by stress factors easy hypomania，mostly when accompanied by nervous symptoms "as a state"，"mannerisms" dramatic behavior，within 1 week of treatment could relieve and the reaction was sensitive to the group A.BPRS assessment after symptom remission showed that the scores of "activated"，"anxiety depression" factors in group A were higher than those in group B（P<0.05）."the lack of vitality"，"hostile suspicion" factor and “thought obstacle” factor score in group A were significantly higher than those in group A（P<0.05）.Conclusion：Nervous symptoms associated with schizophrenia and bipolar disorders，but the differences are statistically significant in the onset of both forms，the impact of stress，personality characteristics and treatment response of the two groups.And after symptom remission，the "lack of vitality"，"hostile suspicion "" thought disorder " of group A are significantly different from the excitement，anxiety and other emotional characteristics of group B.

【Key words】 Nervous； Women； Bipolar disorder； Schizophrenia

First-authors address：The Second Peoples Hospital of Chuxiong Prefecture，Chuxiong 675000，China

doi：10.3969/j.issn.1674-4985.2014.25.003

緊張性癥狀為臨床精神科急性綜合征，對其的診斷多從精神分裂癥考慮。但有調(diào)查顯示，緊張癥性障礙患者自殺者不在少數(shù)，且被診斷為情感性障礙，其中以雙相情感障礙者居多[1-2]。本研究對伴緊張癥狀精神分裂癥與雙相情感障礙患者的臨床現(xiàn)象進(jìn)行了對比，以探討伴緊張癥狀女性雙相情感障礙的臨床特點(diǎn)。endprint

1 資料與方法

1.1 一般資料 回顧性分析入院時(shí)伴緊張癥狀、出院時(shí)符合ICD-10（疾病及有關(guān)健康問題的國際分類[3]）的緊張型精神分裂癥（A組）與雙相情感障礙癥（B組）各30例患者的臨床資料。其中患者年齡17～45歲，平均（33.9±6.7）歲；兩組患者病期分別為（37.9±17.7）d、（18.0±13.4）d；31例為首發(fā)，29例為復(fù)發(fā)；A組與B組的入院診斷符合率為93.3%、60.0%。所有患者均符合如下診斷標(biāo)準(zhǔn)：（1）符合Taylar與Fink中關(guān)于緊張性癥狀的界定標(biāo)準(zhǔn)；（2）患者多表現(xiàn)出的緊張性癥狀并非受到精神活性物質(zhì)或抗精神病藥物所致；（3）患者雖伴既往精神病性障礙，但接受臨床治療后均徹底緩解，且此后未經(jīng)服用其他抗精神病類藥物；（4）排除腦器質(zhì)性疾病患者；（5）患者入選年齡為15～45周歲[4-5]。兩組患者一般資料比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05），具有可比性。