醫週譯:Bipolar disorder / 躁鬱症

Bipolar disorder, also known as bipolar affective disorder (and originally called manic-depressive illness), is a mental disorder characterized by periods of elevated mood and periods of depression.[1][2] The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis. During mania an individual feels or acts abnormally happy, energetic, or irritable.[1] They often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced.[2] During periods of depression there may be crying, poor eye contact with others, and a negative outlook on life.[1]The risk of suicide among those with the disorder is high at greater than 6% over 20 years, while self harm occurs in 30–40%.[1]Other mental health issues such as anxiety disorder and drug misuse are commonly associated.[1]

躁鬱症({{lang-en|bipolar disorder}},亦稱雙極性情感疾患,早期稱為躁狂抑鬱疾病),是一種[[精神病|精神疾病]],特徵為患者會經歷情緒的亢奮和{{link-en|抑鬱|Major depressive episode}}<ref name=BMJ2012/><ref name=DSM5/>。情緒亢奮期(躁期)可分為「{{link-en|狂躁|Mania}}」或是「[[輕度狂躁|輕躁狂]]」,兩者的區別在於是否影響生活及工作和是否出現精神病症狀。於狂躁期,患者感到或表現出異常開心、有活力、易怒<ref name=BMJ2012/>,常會做出不計後果的決定,對睡眠的需求也往往會減少<ref name=DSM5/>。於抑鬱期,患者會哭泣、缺乏與他人眼神交流、對生命萌生負面看法<ref name=BMJ2012/>,也有[[自殺]]的可能。病史長達20年以上的患者,其自殺風險超過6%,{{link-en|自殘|Self-harm}}風險則約30-40%<ref name=BMJ2012>{{cite journal|last1=Anderson|first1=IM|last2=Haddad|first2=PM|last3=Scott|first3=J|title=Bipolar disorder.|journal=BMJ (Clinical research ed.)|date=Dec 27, 2012|volume=345|pages=e8508|pmid=23271744|doi=10.1136/bmj.e8508}}</ref>。躁鬱症也常伴隨[[焦慮症]]以及[[物質濫用|藥物濫用]]等心理問題<ref name=BMJ2012/>。

The cause is not clearly understood, but both genetic and environmental factors play a role.[1] Many genes of small effect contribute to risk.[1][3] Environmental factors include long term stress and a history of childhood abuse.[1] It is divided into bipolar I disorder if there is at least one manic episode and bipolar II disorder if there are at least one hypomanic episode and one major depressive episode. In those with less severe symptoms of a prolonged duration the condition cyclothymic disorder may be present. If due to drugs or medical problems it is classified separately.[2] Other conditions that may present in a similar manner include: drug misuse,personality disorders, attention deficit hyperactivity disorder, and schizophrenia  as well as a number of medical conditions.[1]

躁鬱症發生的原因不明,先天基因與後天環境都有影響<ref name=BMJ2012/><ref>{{cite journal|last1=Goodwin|first1=Guy M.|title=Bipolar disorder|journal=Medicine|volume=40|issue=11|pages=596–598|doi=10.1016/j.mpmed.2012.08.011}}</ref>。許多基因都會略為增加發生躁鬱症的風險,但目前尚沒有找到佔主要角色的基因,還有如長期{{link-en|壓力 (心理學)|Stress (psychological)|壓力}}和[[虐待兒童|童年受虐]]等環境因素,都有可能致病<ref name=BMJ2012/>。若患者經歷一次以上的躁期,稱為{{link-en|第一型躁鬱症|Bipolar I disorder}};若患者經歷一次以上的輕躁期加上一次重鬱期,稱為{{link-en|第二型躁鬱症|Bipolar II disorder}}。症狀較輕但持續時間較長的患者則可能屬於[[循環性情感症|循環性精神失調]],如果該現象是由藥物引發,則不能診斷為雙極性情感疾患<ref name=DSM5>。會出現類似症狀的疾病和情況包括:藥物濫用、[[人格障礙|性格異常]] 、[[注意力不足過動症|過動]] 、[[思覺失調症]]以及數種醫療狀況<ref name=BMJ2012/>。

Treatment commonly includes psychotherapy and medications such as mood stabilizers or antipsychotics. Examples of mood stabilizers that are commonly used include: lithium and anticonvulsants. Treatment in hospital against a person’s wishes may be required at times as people may be at risk to themselves or others yet refuse treatment. Severe behavioural problems may be managed with short term benzodiazepines or antipsychotics. In periods of mania it is recommended that antidepressants be stopped. If antidepressants are used for periods of depression they should be used with a mood stabilizer. Electroconvulsive therapymay be helpful in those who do not respond to other treatments. If treatments is stopped it is recommended that this be done slowly. Most people have social, financial or work related problem due to the disorder. These difficulties occur a quarter to a third of the time on average. The risk of death from natural causes such as heart disease is twice that of the general population. This is due to poor lifestyle choices and the side effects from medications.[1]

躁鬱症的治療通常包括[[心理治療]]以及使用{{link-en|情緒穩定劑|Mood stabilizer}}或[[抗精神病藥|抗精神病藥物]]。常用的情緒穩定劑包括[[鋰 (藥理學)|鋰鹽]]和部分的{{link-en|抗癲癇藥物|Anticonvulsant}}。如果病人有傷害自己或他人的風險,即使病人本身不願意接受治療可能還是有強制治療的必要。如果認為病人的風險和情療有住院治療必要,在經過兩位精神專科醫師鑑定後可以強制病人住院接受治療(在離島時鑑定流程則可以由一位專科醫師完成)。嚴重的行為問題在急性期可以用[[苯二氮平類藥物]]或抗精神病藥物處理。若病人有有服用抗憂鬱藥物,在躁狂期建議應停藥,若不停藥則應該加上情緒穩定劑,對於其他治療手段反應都不佳且症狀嚴重的病人可能會對[[電痙攣療法]]有反應。假如因病人狀況而需要停藥,不可以貿然停止而必須慢慢減低劑量。一般而言,有三分之一到四分之一病人為社交、經濟或是工作上的問題所苦。躁鬱症患者相對於一般人,由於{{link-en|自然原因死亡|Death by natural causes|自然原因}}(如心臟病等)死亡的風險是常人的兩倍,這通常是由於生活習慣不佳或是藥物副作用<ref name=BMJ2012/>。

About 3% of people in the United States have bipolar disorder at some point in their life.[4] Lower rates of around 1% are found in other countries. The most common age at which symptoms begin is 25.[1] Rates appear to be similar in males as females.[5] The economic costs of the disorder has been estimated at $45 billion for the United States in 1991.[6] A large proportion of this was related to a higher number of missed work days estimated at 50 per year.[6] People with bipolar disorder often face problems with social stigma.[1]

約有3%的美國人在一生當中會經歷躁鬱症發作<ref name="Schmitt2014">{{cite journal | author = Schmitt A, Malchow B, Hasan A, Falkai P | title = The impact of environmental factors in severe psychiatric disorders | journal = Front Neurosci | volume = 8 | issue = 19 | date = February 2014 | pmid = 24574956 | pmc = 3920481 | doi = 10.3389/fnins.2014.00019 }}</ref>,在其他國家的盛行率較低(大約是1%)。一般而言,躁鬱症常發作在25歲前後<ref name=BMJ2012/>,不同性別間的發生率並沒有差別<ref>{{cite journal|last1=Diflorio|first1=A|last2=Jones|first2=I|title=Is sex important? Gender differences in bipolar disorder.|journal=International review of psychiatry (Abingdon, England)|date=2010|volume=22|issue=5|pages=437–52|pmid=21047158|doi=10.3109/09540261.2010.514601}}</ref>。躁鬱症在1991年的美國大約消耗450億美元的經濟成本<ref name=Hirs205/>,這當中大部分是由於因躁鬱症而損失的工作日數(每年約50日)<ref name=Hirs205>{{cite journal|last1=Hirschfeld|first1=RM|last2=Vornik|first2=LA|title=Bipolar disorder—costs and comorbidity.|journal=The American journal of managed care|date=Jun 2005|volume=11|issue=3 Suppl|pages=S85-90|pmid=16097719}}</ref>。躁鬱症患者也經常需要面對{{link-en|社交汙名化|Social stigma}}的問題<ref name=BMJ2012/>。

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