34例躁狂抑郁症误诊的分析

Analysis of 34 misdiagnosis cases of manicdepressive psychosis

该文报道80例确诊的躁狂抑郁症者中有34例曾误诊为其它精神病,误诊率为42.5%。其中30例(88.2%)曾误诊为精神分裂症,4例曾误诊为神经衰弱者,全系首次发作为抑郁相。双相II型18例中有9例曾漏诊其抑郁发作史。从误诊原因分析:①有20/34例(59.8%)临床症状不典型;②检查中忽视内心体验的询问(24/34例,70.6%)及躯体性症状的了解(25/34例,73.5%);③对某些症状的误解,如思维奔逸误为思维松驰,对情绪不稳、激惹在躁郁症中意义认识不清;④对躁郁症中可伴有与心境不协调的重性精神病症状缺乏认识。

In 80 established cases of manic-depressive psychosis 34 were considered (42.5%) to be misdiagnosed of these cases, 30 misdiagnosed as schizophrenia, and 4 as neurasthenia, in the 4 latter cases the attacks of depression were documented, In 9 of 18 bipolar I cases the history of depressive episodes used to be neglected Reasons of misdiagnosis are as follows:(1) The clinical symptoms were nottypical, in 59.8%of cases(20/34).(2) Unaware of either patients inner experiences (24/34 cases 70.6%) or somatic complaints (25/34 cases, 73.5%)(3)Misinterpretation of some symptoms, as pointed out in this article(4)Neglect the possibility of coexistence of either mood-congruent or mood-incongruent Psychotic features in manic-depressive Psychosis.