有精神病性症状躁狂发作的临床特征研究

The clinic study on manic episode with psychotic symptoms

目的探讨有精神病性症状的躁狂发作的临床特征。方法使用自编的一般情况问卷及有精神病性症状的躁狂发作的精神症状调查问卷,共收集135例"有精神病性症状的躁狂发作"患者,并根据患者的精神病性症状是否与心境相协调进一步分成两组(非典型组59例和典型组76例),比较两组间临床资料的异同。结果在有精神病性症状的躁狂发作中,伴有与心境不协调的精神病性症状的非典型躁狂发作占43.7%、伴有与心境协调的精神病性症状的典型躁狂发作占56.3%,非典型躁狂发作在起病形式、病程特点、病前社会功能、病前性格、首发症状及近期疗效与典型躁狂发作相比有显著性差异(P<0.05),典型组在起病形式上以急性起病者居多,病程多表现为间歇性病程,病前社会功能良好,性格以外向者居多,多以情感症状为首发症状及近期疗效相对较好。结论伴有与心境协调的精神病性症状的典型躁狂发作和伴有与心境不协调的精神病性症状的非典型躁狂发作在临床上均极为常见,非典型躁狂发作为躁狂发作的一个特殊的亚型,我们应对其加强认识。

Objective To explore the clinic feature of manic episode with psychotic symptoms. Methods A total of 135 manic episode patients with psychotic symptoms were assessed by the self-compiled General Information Inventory（GII） and the manic episode with psychotic symptoms investigate inventory. On the basis of the harmony between psychotic symptoms and mood, the patients were divided into two groups（59 atypical cases and 76 typical cases） and the clinic features were compared between the two groups. Results 43.7 % of patients were atypicai manic episode（mood-incongruence） and 56.30% of the patients were typical manic episode （mood-congruence） in manic episode with psychotic symptoms. There were singnificant differences in type of onset,characteristics of duration, social function and feature of personality before the disease, earlist symptom and efficacy between atypical manic episode and typical manic episode. The patients of atypical manic episode manifested acute onset , the intermittence course of disease, good social function before the index episode, the extroversive personality, affective symptoms as the earliest symptoms, and good pharmotherapeutic response. Conclusion Typical manic episode （mood-congruence） and atypical manic episode （mood-incongruence） were very common in clinic. Atypical manic episode may be a special subtype of the manic episode and we should strengthen cognition.