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分离性身份障碍英语作文Dissociative Identity Disorder: Understanding the Complex Phenomenon.Dissociative identity disorder (DID), previously known as multiple personality disorder, is a complex psychological condition characterized by the presence of two or more distinct personality states or identities that alternately take control of an individual's behavior. These distinct identities, known as alters, are often associated with different memories, emotions, and behaviors, which can be extremely disruptive and debilitating for those experiencing it. DID is a controversial diagnosis, and its existence has been hotly debated within the psychological community. However, it is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a valid condition that requires careful assessment and treatment.The etiology of DID is multifaceted and often involves a combination of genetic, neurobiological, andenvironmental factors. Trauma, particularly childhood abuse or neglect, is a common trigger for the development of DID. The repeated and severe psychological stress associated with such trauma can lead to the dissociation of memories, emotions, and even identity, resulting in the emergence of multiple alters. These alters may serve as coping mechanisms, allowing the individual to escape from the overwhelming emotional pain and memories associated with the trauma.The symptoms of DID can be diverse and vary among individuals. Common symptoms include memory loss or distortion, feelings of detachment or estrangement from oneself or one's environment, and the presence of distinct alters with their own identities, memories, and behaviors. These alters may have different names, ages, genders, and even personal histories. They may take control of the individual's behavior at different times, leading to confusion, discontinuity, and a sense of loss of control.The diagnosis of DID is challenging due to its complexity and the subjective nature of the symptoms. Itrequires a thorough assessment by a trained mental health professional, who must rule out other potential causes of the symptoms, such as schizophrenia, bipolar disorder, or malingering. DID is diagnosed based on the presence of at least two distinct alters, which recurrently take control of the individual's behavior, and significant memory loss, confusion, or discontinuity in the individual's self-perception, affect, or behavior.The treatment of DID is also complex and requires a multifaceted approach. Therapy, particularly psychotherapy, is a crucial component of treatment. Techniques such as cognitive-behavioral therapy (CBT) and psychodynamic therapy can help individuals gain insight into their condition, manage their symptoms, and develop healthier coping mechanisms. Medication may also be used to address comorbid conditions such as depression or anxiety.In addition to therapy, lifestyle changes can also be beneficial for individuals with DID. Establishing a regular sleep schedule, engaging in physical activities, and maintaining a healthy diet can help improve overall well-being and reduce stress. Support groups and peer-support networks can also provide a sense of community and understanding for those with DID.It is important to note that DID is a chronic condition that may require lifelong management. However, with the appropriate treatment and support, individuals with DID can lead fulfilling and productive lives. It is crucial to approach DID with an open and understanding mindset, recognizing that it is a real and debilitating condition that requires compassion and support.In conclusion, dissociative identity disorder is a complex psychological condition that requires careful assessment and treatment. It is characterized by the presence of two or more distinct alter egos thatalternately take control of an individual's behavior. The etiology of DID is multifaceted and often involves a combination of genetic, neurobiological, and environmental factors. The diagnosis is challenging due to its complexity and the subjective nature of the symptoms. Treatment involves a multifaceted approach, including psychotherapy,medication, and lifestyle changes. With the appropriate treatment and support, individuals with DID can lead fulfilling and productive lives.。
非典型抗精神病药物用于治疗双相情感障碍摘要】随着临床应用的普遍，非典型抗精神病药物已不单纯作为精神分裂症的治疗，在双相障碍治疗中，其应用也越来越受到临床工作者的关注。
非典型抗精神病药物对于双相障碍躁狂相和抑郁相的急性发作期的治疗，疗效肯定，不良反应少见，安全耐受。
本文主要介绍非典型抗精神病药物在双相障碍治疗中的应用，为临床合理用药提供参考。
【关键词】非典型抗精神病药物；治疗；双相情感障碍【中图分类号】R749.053 【文献标识码】A 【文章编号】2095-1752（2015）08-0010-03Atypical antipsychotic drugs used to treat bipolar disorder Yin Haogui. JinshanMental Health Centerof Shanghai, Shanghai 201515, China【Abstract】As the clinical application of universal, atypical antipsychotics have not just as the treatment of schizophrenia, in bipolar disorder treatment, its application is becoming more and more attention by clinical workers. Atypical antipsychotics for bipolar mania and depression phase in the acute phase of treatment, curative effect and adverse reaction of rare, safety tolerance. This paper mainly introduces the atypical antipsychotic drugs in the treatment of bipolar disorder, provide reference for clinical rational drug use.【Key words】 Atypical antipsychotic drugs; Treatment; Bipolar disorder双相障碍（bipolar disorder, BP）也称双相情感障碍，是指既有符合症状学诊断标准的躁狂或轻躁狂发作、又有抑郁发作的一类心境障碍。
Bipolar and Related DisordersBipolar DisordersTo enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood. The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed. Instead, a new specifier, “with mixed features,” has been added that can be applied to episodes of mania or hypomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present. Other Specified Bipolar and Related DisorderDSM-5 allows the specification of particular conditions for other specified bipolar and related disorder, including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion (i.e., at least 4 consecutive days). A second condition constituting an other specified bipolar and related disorder is that too few symptoms of hypomania are present to meet criteria for the full bipolar II syndrome, although the duration is sufficient at 4 or more days.Anxious Distress SpecifierIn the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for anxious distress is delineated. This specifier is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria. Depressive DisordersDSM-5 contains several new depressive disorders, including disruptive mood dysregulation disorder and premenstrual dysphoric disorder. To address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children, a new diagnosis, disruptive mood dysregulation disorder, is included for children up to age 18 years who exhibit persistent irritability and frequent episodes of extreme behavioral dyscontrol. Based on strong scientific evidence, premenstrual dysphoric disorder has been moved from DSM-IV Appendix B, “Criteria Sets and Axes Provided for Further Study,” to the main body of DSM-5. Finally, DSM-5 conceptualizes chronic forms of depression in a somewhat modified way. What was referred to as dysthymia in DSM-IV now falls under the category of persistent depressive disorder, which includes both chronic major depressive disorder and the previous dysthymic disorder. An inability to find scientifically meaningful differences between these two conditions led to their combination with specifiers included to identify different pathways to the diagnosis and to provide continuity with DSM-IV.Major Depressive DisorderNeither the core criterion symptoms applied to the diagnosis of major depressive episode nor the requisite duration of at least 2 weeks has changed from DSM-IV. Criterion A for a major depressive episode in DSM-5 is identical to that of DSM-IV, as is the requirement for clinically significant distress or impairment in social, occupational,or other important areas of life, although this is now listed as Criterion B rather than Criterion C. The coexistence within a major depressive episode of at least three manic symptoms (insufficient to satisfy criteria for a manic episode) is now acknowledged by the specifier “with mixed features.” The presence of mixed features in an episode of major depressive disorder in Highlights of Changes from DSM-IV-TR to DSM-5 • 5creases the likelihood that the illness exists in a bipolar spectrum; however, if the individual concerned has never met criteria for a manic or hypomanic episode, the diagnosis of major depressive disorder is retained.Bereavement ExclusionIn DSM-IV, there was an exclusion criterion for a major depressive episode that was applied to depressive symptoms lasting less than 2 months following the death of a loved one (i.e., the bereavement exclusion). This exclusion is omitted in DSM-5 for several reasons. The first is to remove the implication that bereavement typically lasts only 2 months when both physicians and grief counselors recognize that the duration is more commonly 1–2 years. Second, bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss. When major depressive disorder occurs in the context of bereavement, it adds an additional risk for suffering, feelings of worthlessness, suicidal ideation, poorer somatic health, worse interpersonal and work functioning, and an increased risk for persistent complex bereavement disorder, which is now described with explicit criteria in Conditions for Further Study in DSM-5 Section III. Third, bereavement-related major depression is most likely to occur in individuals with past personal and family histories of major depressive episodes. It is genetically influenced and is associated with similar personality characteristics, patterns of comorbidity, and risks of chronicity and/or recurrence as non–bereavement-related major depressive episodes. Finally, the depressive symptoms associated with bereavement-related depression respond to the same psychosocial and medication treatments as non–bereavement-related depression. In the criteria for major depressive disorder, a detailed footnote has replaced the more simplistic DSM-IV exclusion to aid clinicians in making the critical distinction between the symptoms characteristic of bereavement and those of a major depressive episode. Thus, although most people experiencing the loss of a loved one experience bereavement without developing a major depressive episode, evidence does not support the separation of loss of a loved one from other stressors in terms of its likelihood of precipitating a major depressive episode or the relative likelihood that the symptoms will remit spontaneously.Specifiers for Depressive DisordersSuicidality represents a critical concern in psychiatry. Thus, the clinician is given guidance on assessment of suicidal thinking, plans, and the presence of other risk factors in order to make a determination of the prominence of suicide prevention in treatment planning for a given individual. A new specifier to indicate the presence of mixed symptoms has been added across both the bipolar and the depressive disorders, allowing for thepossibility of manic features in individuals with a diagnosis of unipolar depression. A substantial body of research conducted over the last two decades points to the importance of anxiety as relevant to prognosis and treatment decision making. The “with anxious distress” specifier gives the clinician an opportunity to rate the severity of anxious distress in all individuals with bipolar or depressive disorders.。
心境情感障碍英语怎么说在英语中，"心境情感障碍"可以表达为 "mood disorders" 或"affective disorders"。
这类障碍通常涉及情绪状态的异常，如抑郁或躁狂，它们可能会对个人的日常生活和功能产生显著影响。
Mood disorders are a group of mental health conditions that affect the way a person feels, thinks, and behaves. They can cause a wide range of mood changes, from feeling sad or hopeless to feeling overly happy or energized. Here are some common types of mood disorders:1. Major Depressive Disorder (MDD): Also known as clinical depression, it is characterized by a persistent feeling of sadness and loss of interest in activities.2. Bipolar Disorder: Previously known as manic-depressive illness, this disorder involves episodes of depression and mania, which is an abnormally elevated mood.3. Dysthymia: A mild but long-lasting form of depression that can last for years.4. Cyclothymic Disorder: A milder form of bipolar disorder with alternating periods of depression and hypomania.5. Seasonal Affective Disorder (SAD): A type of depression that occurs at the same time each year, typically in the fall and winter months.6. Premenstrual Dysphoric Disorder (PMDD): A severe form of premenstrual syndrome (PMS) that can cause significant mood swings and depression.7. Postpartum Depression: A type of depression that many women experience after giving birth.These disorders are often treated with a combination of medication, therapy, and lifestyle changes. It's important for individuals experiencing mood disorders to seek professional help to manage their symptoms and improve their quality of life.。
双相情感障碍英语全称Bipolar Disorder, in English, is fully referred to as "Bipolar Affective Disorder" or "Manic-Depressive Illness." It is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These episodes can vary in intensity and duration, and they can significantly impact a person'sability to function in daily life.The term "bipolar" comes from the Greek words "bi" meaning two and "polar" referring to the poles or extremes. It reflects the two contrasting emotional states thatindividuals with this disorder experience.Bipolar Disorder is further categorized into different types:1. Bipolar I Disorder: This is characterized by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.2. Bipolar II Disorder: This involves at least one major depressive episode and at least one hypomanic episode, but no full-blown manic episodes.3. Cyclothymic Disorder (or Cyclothymia): This is a milder form of the condition, with alternating hypomanic and depressive symptoms, but they are less severe than in Bipolar I or II.4. Other specified and unspecified bipolar and related disorders: These categories are used when the presentation of the symptoms doesn't fit neatly into the other categories.It's important to note that Bipolar Disorder is a serious medical condition that requires professional diagnosis and treatment. Treatment often includes a combination of medication, psychotherapy, and lifestyle changes to manage the symptoms effectively.。
2012年英语二考试text3部分题目是什么，内容如何？1. 题目回顾2012年英语二考试text3部分主要涉及了媒体报道和社会现象的关系。
具体题目为：“Why is there such an explosion of media interest about bipolar disorder (躁狂抑郁症), which has sent the famous into rehab and given physicians endless headaches?”2. 题目分析这道题目主要涉及两个方面：一是探讨躁狂抑郁症为何成为媒体关注的焦点，二是疾病给医生带来的困扰。
文章需要从媒体报道和社会现象的角度，以及疾病对医生的影响两个方面展开论述，分析原因和影响。
3. 文章结构建议（1）引言部分：介绍躁狂抑郁症近年来成为媒体关注的热点现象，引出本文要探讨的内容。
（2）主体部分一：分析躁狂抑郁症成为媒体焦点的原因，可能涉及疾病的患者群体、病情的突出特征等。
（3）主体部分二：分析媒体对躁狂抑郁症报道的影响，可能包括公众对疾病的认知、患者的心理状态等。
（4）主体部分三：探讨躁狂抑郁症给医生带来的困扰，可能包括诊断难、治疗挑战等方面。
（5）结论部分：总结文章要点，呼吁人们正确看待媒体报道，关注真正的疾病问题。
4. 解题建议在阅读文章材料的要注意材料所涉及的关键词，比如“bipolar disorder”、“media interest”、“famous”、“physicians”等，从而把握文章的主旨和要点。
在分析题目的要明确文章的结构，合理安排各个部分的内容，确保文章逻辑清晰，观点表达准确。
5. 注意事项在撰写文章时，要尽量采用准确的词汇和句式，避免语法错误和拼写错误。
另外，在论述问题时，要客观理性，不偏袒任何一方观点，避免出现主观臆断和情绪化表述。
对于文章的结构和逻辑要求也要严格把握，确保文章表达清晰有序，层次分明。
作者简介:左燕,女,主管药师,主要从事药学研究㊂ ә 通信作者,E -m a i l :417491962@q q.c o m ㊂㊃论 著㊃D O I :10.3969/j.i s s n .1672-9455.2024.01.023碳酸锂联合丙戊酸镁治疗双相情感障碍躁狂发作的疗效及对血清B D N F ㊁认知功能的影响左 燕1,李方捷2ә1.上海市宝山区精神卫生中心药剂科,上海201999;2.上海市精神卫生中心药学部,上海200030摘 要:目的 探讨双相情感障碍患者采用碳酸锂联合丙戊酸镁治疗躁狂发作的效果及对血清脑源性神经营养因子(B D N F )㊁认知功能的影响㊂方法 采用随机数字表法将上海市宝山区精神卫生中心2021年4月至2023年4月诊治的120例双相情感障碍躁狂发作患者分为对照组和观察组,各60例㊂对照组患者使用碳酸锂治疗,观察组在对照组基础上加用丙戊酸镁治疗㊂比较两组患者的疗效㊁治疗前后的血清B D N F 水平㊁认知功能强弱及倍克-拉范森躁狂量表(B R M S)评分;观察两组不良反应发生情况㊂结果 观察组的治疗总有效率为93.33%,明显高于对照组的70.00%(χ2=5.454,P =0.020)㊂治疗后两组B D N F 水平升高,观察组B D N F 水平高于对照组,差异均有统计学意义(P <0.05)㊂治疗4周后,两组患者的B R M S 评分均低于治疗前,观察组显著低于对照组,差异均有统计学意义(P <0.05);两组患者的威斯康星片分类测验(W C S T )评分㊁言语记忆测验(HV L T -R )评分㊁持续操作测验评分(C P T )均高于治疗前,观察组显著高于对照组,差异均有统计学意义(P <0.05)㊂两组总不良反应发生率比较,差异无统计学意义(χ2=1.294,P =0.706)㊂结论 碳酸锂联合丙戊酸镁治疗双相情感障碍的疗效较佳,不仅能有效改善躁狂症状,而且能提高血清B D N F 水平和认知功能评分㊂关键词:双相情感障碍; 躁狂发作; 丙戊酸镁; 碳酸锂; 脑源性神经营养因子; 认知功能中图法分类号:R 749.4文献标志码:A文章编号:1672-9455(2024)01-0099-04E f f i c a c y o f l i t h i u m c a r b o n a t e c o m b i n e d w i t h m a g n e s i u m v a l p r o a t e i n t r e a t i n g b i po l a r d i s o r d e r m a n i c e p i s o d e a n d i t s e f f e c t o n s e r u m B D N F a n d c o gn i t i v e f u n c t i o n Z U O Y a n 1,L I F a n g ji e 2ә1.D e p a r t m e n t o f P h a r m a c y ,B a o s h a n D i s t r i c t M e n t a l H e a l t h C e n t e r ,S h a n gh a i 201999,C h i n a ;2.D e p a r t m e n t o f P h a r m a c y ,S h a n g h a i M e n t a l H e a l t h C e n t e r ,S h a n g h a i 200030,C h i n a A b s t r a c t :O b je c t i v e T o e x p l o r e t h e ef f i c a c y o f l i t h i u m c a r b o n a t e c o m b i n e d w i t h m ag n e s i u m v a l p r o a t e i n th e t r e a t m e n t o f bi p o l a r d i s o r d e r m a n i c e p i s o d e a n d i t s e f f e c t o n s e r u m b r a i n -d e r i v e d n e u r o t r o p h i c f a c t o r (B D -N F )a n d c o g n i t i v e f u n c t i o n .M e t h o d s A t o t a l o f 120p a t i e n t s w i t h b i p o l a r d i s o r d e r m a n i c e p i s o d e d i a gn o s e d i n B a o s h a n D i s t r i c t M e n t a l H e a l t h C e n t e r f r o m A p r i l 2021t o A p r i l 2023w e r e d i v i d e d i n t o t h e c o n t r o l g r o u p an d o b s e r v a t i o n g r o u p b y t h e r a n d o m n u m b e r t a b l e m e t h o d ,60c a s e s i n e a c h g r o u p .T h e c o n t r o l g r o u p wa s t r e a t e d w i t h l i t h i u m c a rb o n a t e ,a n d t h e o b s e r v a t i o n g r o u p w a s a d d e d w i t h m a g n e s i u m v a l pr o a t e o n t h e b a s i s o f c o n t r o l g r o u p .T h e t r e a t m e n t e f f i c a c y ,s e r u m B D N F l e v e l ,s t r o n g n e s s a n d w e a k n e s s o f c o gn i t i v e f u n c t i o n a n d t h e P i k e l a f a n s e n M a n i a S c a l e (B R M S )s c o r e b e f o r e a n d a f t e r t r e a t m e n t w e r e c o m p a r e d b e t w e e n t h e t w o g r o u p s .T h e a d v e r s e r e a c t i o n s o c c u r r e n c e w a s o b s e r v e d i n t h e t w o g r o u ps .R e s u l t s T h e t o t a l e f f e c t i v e r a t e i n t h e o b -s e r v a t i o n g r o u p w a s 93.33%,w h i c h w a s h i g h e r t h a n 70.00%i n t h e c o n t r o l g r o u p (χ2=5.454,P =0.020).A f t e r t r e a t m e n t ,t h e B D N F l e v e l o f t h e t w o g r o u p s i n c r e a s e d ,a n d t h e B D N F l e v e l o f t h e o b s e r v a t i o n g r o u pw a s h i g h e r t h a n t h a t o f t h e c o n t r o l g r o u p ,a n d t h e d i f f e r e n c e s w e r e s t a t i s t i c a l l y s i gn i f i c a n t (P <0.05).A f t e r t h e 4w e e k s t r e a t m e n t ,B R M S s c o r e s i n t h e t w o g r o u ps w e r e l o w e r t h a n t h o s e b e f o r e t r e a t m e n t ,t h e o b s e r v a -t i o n g r o u p w a s s i g n i f i c a n t l y l o w e r t h a n t h e c o n t r o l g r o u p ,a n d t h e d i f f e r e n c e s w e r e s t a t i s t i c a l l y s i gn i f i c a n t (P <0.05).T h e s c o r e s o f W i s c o n s i n T a b l e t C l a s s i f i c a t i o n T e s t (W C -S T ),v e r b a l m e m o r y te s t (V L T -R )a n d c o n t i n u o u s o p e r a t i o n t e s t (C P T )af t e r t r e a t m e n t i n t h e t w og r o u p s w e r ehi gh e r t h a n t h o s e b e f o r e t r e a t m e n t ,m o r e o v e r t h e o b s e r v a t i o n g r o u p w a s s i g n i f i c a n t l y h i g h e r t h a n t h e c o n t r o l g r o u p,a n d t h e d i f f e r e n c e s w e r e s t a -t i s t i c a l l y s i gn i f i c a n t (P <0.05).T h e t o t a l o c c u r r e n c e r a t e s o f a d v e r s e r e a c t i o n s h a d n o s t a t i s t i c a l d i f f e r e n c e b e -t w e e n t h e t w o g r o u p s (χ2=1.294,P =0.706).C o n c l u s i o n L i t h i u m c a r b o n a t e c o m b i n e d w i t h m a gn e s i u m v a l -p r o a t e h a s g o o d e f f e c t i n t r e a t i n g b i p o l a r d i s o r d e r ,n o t o n l y e f f e c t i v e l y i m p r o v e s t h e m a n i c s y m pt o m s ,b u t a l s o ㊃99㊃检验医学与临床2024年1月第21卷第1期 L a b M e d C l i n ,J a n u a r y 2024,V o l .21,N o .1i n c r e a s e s s e r u m B D N F l e v e l a n d c o g n i t i v e f u n c t i o n s c o r e s.K e y w o r d s:b i p o l a r d i s o r d e r; m a n i c e p i s o d e; m a g n e s i u m v a l p r o a t e;l i t h i u m c a r b o n a t e; b r a i n-d e-r i v e d n e u r o t r o p h i c f a c t o r;c o g n i t i v e f u n c t i o n双相情感障碍是一种常见的致残性精神疾病,如果治疗不当可导致患者出现躁狂发作或双相抑郁症,并交替发作,病程较长,严重影响患者身心健康,损害社会功能与生命质量[1]㊂目前在临床中,双相情感障碍患者处于躁狂发作时主要采用药物治疗,而碳酸锂是一种应用频率较高㊁使用广泛的药物,它能够有效地减轻患者的躁狂症状[2-3]㊂但该药物治疗无明显镇静作用,对缓解患者躁狂发作效果不够理想,使得部分患者的治疗无法达到预期效果[4]㊂为了确保双相情感障碍的治疗效果,临床医师开始尝试采用联合用药的方式进行治疗且效果较显著㊂丙戊酸镁缓释片为心境稳定剂,具有典型抗癫痫㊁抗狂躁的治疗效果㊂同时,丙戊酸镁对人体中枢神经有明显的抑制效果,通过抑制神经细胞,减少神经元放电和神经冲动的突触传递,从而有效降低神经传导和肌肉的兴奋性,有助于抑制双相情感障碍患者抑郁发作或出现狂躁㊁攻击行为等[5]㊂基于此,本文从血清脑源性神经营养因子(B D N F)表达㊁认知功能及疗效等方面探究丙戊酸镁缓释片联合碳酸锂治疗双相情感障碍躁狂发作的临床应用价值㊂1资料与方法1.1一般资料按随机数字表法将上海市宝山区精神卫生中心2021年4月至2023年4月诊治的120例双相情感障碍躁狂发作患者分为对照组和观察组,各60例㊂对照组:男30例,女30例;年龄21~58岁,平均(32.14ʃ7.72)岁;双相情感障碍病程5个月至4年,平均(2.15ʃ0.76)年㊂观察组:男33例,女27例;年龄21~57岁,平均(32.36ʃ8.12)岁;双相情感障碍病程5个月至5年,平均(2.20ʃ0.68)年㊂两组患者一般资料比较,差异无统计学意义(P>0.05),具有可比性㊂本研究经患者及家属同意,医院伦理委员会已审批通过(审批号:L W-2022-L W-02)㊂纳入标准:与双相情感障碍的相关诊断标准[6]相一致;急性发作;可进行认知功能测试;临床资料完整㊂排除标准:患有其他心理障碍疾病者;严重自杀倾向者;白细胞减少与严重肝脏疾病者;有酗酒㊁吸毒史者;严重心脏疾病患者;治疗依从性差者㊂1.2方法1.2.1治疗方法对照组患者服用碳酸锂片(湖南省湘中制药有限公司,国药准字H43020759)治疗,初始口服按体质量20~25m g/k g计算,600~2000 m g/d,连用1周后调整为500~1000m g/d,分两次服用㊂观察组患者在碳酸锂片基础上服用丙戊酸镁缓释片(湖南省湘中制药有限公司,国药准字H20030537)治疗,初始口服按275m g/d,连用1周后调整为1000~1600m g/d,分两次服用㊂两组均疗程4周㊂1.2.2检测方法血清B D N F检测:采集患者治疗前后5m L的静脉血,经过3000r/m i n离心10m i n 后取上清液㊂采用酶联免疫吸附试验测定B D N F 水平㊂1.3临床疗效判断治疗效果采用倍克-拉范森躁狂量表(B R M S)[10]进行评估,11项因子评分都采用5级评分,分数越高表明狂躁越严重㊂显效:减分率ȡ90%,患者无躁狂症状;显效:75%ɤ减分率<90%,患者狂躁症状明显改善;有效:50%ɤ减分率<75%,患者狂躁症状减轻;无效:减分率<50%,患者躁狂症状无缓解或反而更严重㊂总有效=显效+有效㊂减分率=(治疗后得分-治疗前得分)/治疗前得分ˑ100%㊂1.4观察指标(1)认知功能:采用威斯康星片分类测验(W C S T)[7]在治疗前后对患者的执行能力进行评分;采用言语记忆测验(H V L T-R)[8]对言语记忆学习能力进行评估;采用持续操作测验(C P T)[9]对持续注意力进行评估㊂分数越高代表能力越强㊂(2)比较两组治疗前后血清B D N F水平㊂(3)比较两组疗效㊂(4)不良反应:记录嗜睡㊁恶心呕吐㊁腹泻等不良反应发生情况㊂1.5统计学处理采用S P S S23.0统计软件进行数据分析㊂计数资料以例数或百分率表示,组间比较采用χ2检验;符合正态分布的计量资料以xʃs表示,两组间比较采用t检验㊂以P<0.05为差异有统计学意义㊂2结果2.1治疗前后两组B R M S评分比较治疗后两组B R M S评分降低,且观察组B R M S评分低于对照组,差异均有统计学意义(P<0.05)㊂见表1㊂表1两组治疗前后B R M S评分比较(xʃs,分)组别n治疗前治疗后对照组6035.58ʃ8.7516.52ʃ4.03a观察组6034.66ʃ8.538.26ʃ2.59at0.4089.277P0.685<0.001注:与同组治疗前比较,a P<0.05㊂2.2两组临床疗效比较观察组总有效率(93.33%)优于对照组(70.00%),差异均有统计学意义(P<0.05)㊂见表2㊂2.3治疗前后两组W C S T㊁H V L T-R㊁C P T评分比较治疗后两组W C S T㊁H V L T-R㊁C P T评分均高于㊃001㊃检验医学与临床2024年1月第21卷第1期 L a b M e d C l i n,J a n u a r y2024,V o l.21,N o.1治疗前,且观察组上述评分高于对照组,差异均有统计学意义(P <0.05)㊂见表3㊂2.4 两组血清B D N F 水平比较 治疗后两组B D N F水平均升高,观察组B D N F 水平高于对照组(P <0.05)㊂见表4㊂2.5 两组总不良反应发生率比较 对照组与观察组总不良反应发生率比较,差异无统计学意义(P <0.05)㊂见表5㊂表2 两组临床疗效比较[n (%)]组别n显效有效无效总有效对照组6018(30.00)24(40.00)18(30.00)42(70.00)观察组6024(40.00)32(53.33)4(6.67)56(93.33)χ25.455P0.020表3 两组治疗前后W C S T ㊁HV L T -R ㊁C P T 评分比较(x ʃs ,分)组别nW C S T 评分治疗前治疗后H V L T -R 评分治疗前治疗后C P T 评分治疗前治疗后对照组6047.06ʃ5.6850.76ʃ5.12a 25.88ʃ3.6426.28ʃ4.16a 2.41ʃ0.812.97ʃ0.81a 观察组6047.03ʃ5.6754.66ʃ5.96a25.82ʃ3.3230.55ʃ5.39a2.48ʃ0.764.41ʃ0.88at 0.020-3.8450.067-3.435-0.345-6.594P0.984<0.0010.947<0.0010.731<0.001注:与同组治疗前比较,a P <0.05㊂表4 两组血清B D N F 水平比较(x ʃs ,n g/L )组别n治疗前治疗后对照组6013.25ʃ2.5620.15ʃ2.73a 观察组6013.76ʃ2.6935.74ʃ3.58at 0.75218.967P0.455<0.001注:与同组治疗前比较,aP <0.05㊂表5 两组总不良反应发生率比较[n (%)]组别n嗜睡丙氨酸氨基转移酶升高皮疹总不良反应对照组602(3.33)2(3.33)1(1.67)5(8.33)观察组603(5.00)4(6.67)2(3.33)9(15.00)χ21.294P0.2553 讨 论近年来,随着社会的发展及人们的工作和生活压力加大,越来越多的人开始出现不同程度的精神心理疾病㊂其中,最常见的就是双相情感障碍㊂这类患者在外界刺激㊁气候变化和睡眠不足等情况下容易躁狂发作㊂躁狂发作患者的常见表现有思维混乱㊁情绪高涨㊁睡眠紊乱,甚至出现自杀倾向㊂这种疾病对患者的正常生活造成了很大的影响,不利于患者的身心健康㊂临床医师认为该病与遗传因素㊁多巴胺功能亢进㊁5-羟色胺水平下降㊁生物节律紊乱等多种因素关系密切[10-11],临床上对此病的治疗以药物为主㊂碳酸锂是一种稳定心境的药物,它能有效抑制与脑神经相关的去甲肾上腺素的释放,促进机体分泌5-羟色胺,在稳定患者情绪的同时,还能控制其躁狂症状,减少患者的攻击行为㊂缺点是碳酸锂镇静性不足,单一控制效果较差㊂有关研究结果显示,碳酸锂联合丙戊酸镁用药的效果比单一用药更优[12]㊂本研究结果显示,在治疗后,观察组患者总有效率(93.33%)较对照组患者(70.00%)显著提高,观察组W C S T ㊁H V L T -R ㊁C P T 评分较对照组更高,差异均有统计学意义(P <0.05)㊂分析其原因,丙戊酸镁可以有效改善患者的躁狂情绪,抑制攻击冲动,其作用机制是竞争性抑制γ-氨基丁酸转移酶(G A T ),使其代谢减少从而增强γ-氨基丁酸(G A B A )的神经传递[13]㊂G A B A 是中枢神经中典型的抑制性神经递质,具有镇静神经㊁抗焦躁㊁改善认知的作用,可通过中间神经元调控多巴胺及其他神经递质的传递[14]㊂双相情感障碍患者的认知功能下降,特别是在执行能力㊁言语记忆学习能力㊁持续注意力方面㊂本研究采用W C S T ㊁H V L T -R ㊁C P T 来评估两组患者治疗后认知功能的水平,发现观察组W C S T ㊁H V L T -R ㊁C P T 评分较对照组更高(P <0.05)㊂分析其原因,加用丙戊酸镁治疗后,丙戊酸镁与G A T 结合,竞争性抑制G A T 对谷氨酸的脱羧作用,使脑内G A B A 含量增加,并通过抑制5-羟色胺和多巴胺受体的功能,增加5-羟色胺和多巴胺的传递,从而增强其作用,降低神经兴奋性㊁平抑焦虑,达到更好地改善情绪㊁认知能力㊁抗躁狂㊁抗癫痫的目的[15]㊂这提示两组药品联合应用可提高疗效㊂且观察组与对照组不良反应比较,差异无统计学意义(P >0.05),表明碳酸锂联合丙戊酸镁用药效果优良,有一定安全性,患者及家属容易接受㊂B D N F 是在猪脑中发现的一种具有神经营养作用的蛋白质,属于生长因子神经营养素家族中的一员,是在脑内合成的一种蛋白质,主要分布于中枢神经系统内,可以帮助现存神经元的存活,促进新生神经元和突触的生长和分化及损伤后的再修复,尤其是可以保护认知功能相关的前额叶㊁海马等部位[16]㊂大部分研究认为神经内分泌失调㊁神经细胞因子异常造㊃101㊃检验医学与临床2024年1月第21卷第1期 L a b M e d C l i n ,J a n u a r y 2024,V o l .21,N o .1成神经和精神系统紊乱,进而引发双相情感障碍,因此双相情感障碍患者常有B D N F异常的表现[17-18]㊂本研究发现,观察组治疗后B D N F水平高于对照组,说明碳酸锂和丙戊酸镁联合治疗可有效提升患者血清B D N F水平㊂分析其原因,碳酸锂和丙戊酸钠联合应用能够有效地保护神经细胞,并抑制神经细胞的凋亡,进而刺激神经营养因子分泌,最终为患者神经功能恢复起到了积极的促进作用㊂综上所述,碳酸锂联合丙戊酸镁治疗对躁狂发作患者疗效显著,有助于减轻患者狂躁症状,提高认知能力和血清B D N F水平,值得临床推广试用㊂但本研究存在一定的局限性,比如样本量较小㊁治疗时间短,因此需要进一步开展大样本量㊁长观察期的研究㊂参考文献[1]P A P I O L S,S C HU L Z E T G,H E I L B R O N N E R U.L i t h i-u m r e s p o n s e i n b i p o l a r d i s o r d e r:g e n e t i c s,g e n o m i c s,a n db e y o n d[J].N e u r o sc i L e t t,2022,785:136786.[2]R O O S E N L,S I E N A E R T P.E v i d e n c e-b a s e d t r e a t m e n ts t r a t e g i e s f o r r a p i d c y c l i n g b i p o l a r d i s o r d e r[J].J A f f e c tD i s o r d,2022,311:69-77.[3]方钱禹,吴艳,程良红.无抽搐电休克联合喹硫平对双相情感障碍躁狂发作患者氧化应激水平及认知功能的影响[J].中国医学创新,2023,20(12):47-51.[4]邵国艳.碳酸锂缓释片联合丙戊酸镁缓释片治疗双相情感障碍躁狂发作患者的疗效分析[J].现代诊断与治疗, 2021,32(8):1210-1212.[5]杨程翔,李强,万雅洁,等.丙戊酸镁与齐拉西酮对双相障碍Ⅰ型急性躁狂或混合发作疗效的研究[J].精神医学杂志,2021,34(3):193-197.[6]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志,2001,34(3):184-188.[7]M I L E S S,HOW L E T T C A,B E R R YMA N C,e t a l.C o n-s i d e r a t i o n s f o r u s i n g t h e W i s c o n s i n C a r d S o r t i n g T e s t t o a s s e s s c o g n i t i v e f l e x i b i l i t y[J].B e h a v R e s M e t h o d s,2021, 53(5):2083-2091.[8]SÁE Z-A T X U K A R R O O,D E L P R,P EÑA J,e t a l.H o p-k i n s V e r b a l L e a r n i n g T e s t-r e v i s e d:n o r m a l i z a t i o n a n ds t a n d a r d i z a t i o n f o r S p a n i s h p o p u l a t i o n[J].R e v N e u r o l, 2021,72(2):35-42.[9]W I N T E R D,B R AW Y.O n l i n e s e a r c h s t r a t e g i e s u t i l i z e di n f e i g n i n g a t t e n t i o n d e f i c i t/h y p e r a c t i v i t y d i s o r d e r(A D H D)w h i l e p e r f o r m i n g a c o n t i n u o u s p e r f o r m a n c e t e s t(C P T)[J].A p p l N e u r o p s y c h o l A d u l t,2022,13(6): 1-10.[10]S H I S,L I L,S O N G L,e t a l.E f f e c t o f l a m o t r i g i n e o n c o g-n i t i v e f u n c t i o n a n d s e r u m i n f l a mm a t o r y f a c t o r s i n p a-t i e n t s w i t h d e p r e s s i o n o f r e c u r r e n t b i p o l a r d i s o r d e r[J].P a k J P h a r m S c i,2018,31(6):2775-2778. [11]卜杨,胡光华.碳酸锂联合富马酸喹硫平治疗双相情感障碍躁狂发作的临床研究[J].临床研究,2023,31(1):71-74.[12]余艳,蒋志锋,罗锐,等.丙戊酸钠联合碳酸锂治疗双相情感障碍躁狂发作患者临床效果及对B e c h-R a f a e l s e n躁狂量表评分的影响[J].临床误诊误治,2021,34(8):38-42.[13]陈狄龙,冼彩华,李桀怡.碳酸锂联合丙戊酸镁治疗双相情感障碍躁狂发作的临床疗效[J].慢性病学杂志,2022, 23(9):1314-1316.[14]姚琛潇.基于神经递质失衡探讨以精神症状为主的抗N-甲基-D-天冬氨酸受体脑炎的神经保护研究[D].长沙:湖南中医药大学,2021.[15]Z AMO S C I K V,S C HM I D T S N L,B R A V O R,e t a l.T r y p t o p h a n-e n r i c h e d d i e t o r5-h y d r o x y t r y p t o p h a n s u p-p l e m e n t a t i o n g i v e n i n a r a n d o m i z e d c o n t r o l l e d t r i a l i m-p a c t s s o c i a l c o g n i t i o n o n a n e u r a l a n d b e h a v i o r a l l e v e l[J].S c i R e p,2021,11(1):21637.[16]L I U J N,WA N G S T,L E N G J H,e t a l.I m p a c t s o f g e s t a-t i o n a l d i a b e t e s o n q u a l i t y o f l i f e i n C h i n e s e p r e g n a n t w o m e n i n u r b a n T i a n j i n,C h i n a[J].P r i m C a r e D i a b e t e s, 2020,14(5):425-430.[17]董再全,郝燕妮,沈晓玲,等.不同精神障碍患者神经内分泌异常率和糖调节受损率比较[J].成都医学院学报, 2022,17(4):444-447.[18]张建家,张萍萍.丙戊酸钠联合喹硫平对双相情感障碍合并抑郁症患者疗效及B D N F㊁m i R-381-3p㊁T X A2表达的影响[J].黑龙江医药,2023,36(1):149-151.(收稿日期:2023-07-11修回日期:2023-10-29)(上接第98页)[16]王宝峰,苗卉.二甲双胍联合克罗米酚对多囊卵巢综合征患者血清S H B G及D H E A S水平的影响[J].中国实用医药,2017,12(13):100-101.[17]W E I Y,L U S,HU Y,e t a l.M i c r o R N A-135a r e g u l a t e sv e g f c e x p r e s s i o n a n d p r o m o t e s l u t e i n i z e d g r a n u l o s a c e l la p o p t o s i s i n p o l y c y s t i c o v a r y s y n d r o m e[J].R e p r o d S c i,2020,27(7):1436-1442.[18]陈艳,李源,李海静.阿司匹林联合地屈孕酮治疗多囊卵巢综合征的临床疗效[J].安徽医学,2020,41(5):580-583.[19]孙子懿,雷梦云,刘聪,等.多囊卵巢综合征与单核细胞及炎性细胞因子的关系[J].中国医科大学学报,2018,47(12):1128-1132.[20]谭细凤,李怀芳,王玉凤,等.地屈孕酮联合来曲唑治疗对子宫内膜异位症患者性激素㊁炎性因子㊁C A125及V E G F 的影响[J].基础医学与临床,2019,39(3):392-395. [21]王金英,罗涛,王晓霞,等.来曲唑联合二甲双胍对多囊卵巢综合征患者血清胃生长素㊁性激素及血脂水平的影响及其临床疗效[J].现代生物医学进展,2017,17(16): 3103-3106.(收稿日期:2023-03-16修回日期:2023-10-28)㊃201㊃检验医学与临床2024年1月第21卷第1期 L a b M e d C l i n,J a n u a r y2024,V o l.21,N o.1。
双相情感障碍英语介绍Bipolar disorder, also known as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). These mood shifts can affect a person's ability to function in daily life. Here's an introduction to bipolar disorder in English:Bipolar Disorder: An OverviewBipolar disorder affects millions of people worldwide and is a complex mental health condition that requires careful management and understanding. It is not simply a case of having extreme ups and downs; rather, it is a chronic illness that can be life-altering for those who suffer from it.SymptomsThe symptoms of bipolar disorder are typically divided into two categories: manic episodes and depressive episodes.1. Manic Episodes:- Elevated mood, irritability, or both- Increased energy and activity levels- Rapid speech, racing thoughts, and easily distracted- Overconfidence or inflated self-esteem- Engaging in risky behaviors, such as reckless spending or impulsive decisions- Decreased need for sleep2. Depressive Episodes:- Persistent sadness, anxiety, or emptiness- Loss of interest or pleasure in activities once enjoyed - Feelings of hopelessness or worthlessness- Fatigue or loss of energy- Difficulty concentrating, making decisions, or remembering things- Changes in appetite and weight- Thoughts of death or suicideCausesThe exact cause of bipolar disorder is not known, but it is believed to involve a combination of genetic, environmental, and neurological factors. Research suggests that people with a family history of the disorder are more likely to develop it.TreatmentTreatment for bipolar disorder typically includes a combination of medication, therapy, and lifestyle changes. Medications such as mood stabilizers, antipsychotics, and antidepressants can help manage mood swings. Psychotherapy, including cognitive-behavioral therapy (CBT) and family-focused therapy, can provide additional support and coping strategies.Living with Bipolar DisorderManaging bipolar disorder is a lifelong process. It requires ongoing medical supervision, a strong support system, and personal commitment to treatment. Individuals with bipolar disorder can lead fulfilling lives by adhering to their treatment plans, maintaining a regular sleep schedule, avoiding alcohol and drug use, and engaging in regular exercise and healthy eating habits.ConclusionBipolar disorder is a serious mental health condition that can significantly impact a person's quality of life. However, with proper treatment and support, individuals with this disorder can lead stable and productive lives. It is important to approach the topic with empathy and understanding, recognizing the challenges faced by those who live with bipolar disorder.This introduction provides a basic understanding of bipolar disorder, its symptoms, potential causes, treatment options, and the importance of management for those affected by the condition.。
Surging living costs force Britons to work past retirement age生活成本飙升迫使英国人退休后继续工作The share of older UK workers planning to carry on working in their retirement has nearly doubled in two years due to rising living costs and insufficient pension savings, according to a survey from Abrdn.根据Abrdn的一项调查, 由于生活成本上升和养老金储蓄不足, 计划退休后继续工作的英国老年员工比例在两年内增加了近一倍。
The investment manager’s stark findings underscore the impact of soaring energy and food prices on household budgets, which is pressuring people’s finances as inflation hits a 30-year high.这家投资管理公司的严峻调查结果凸显出能源和食品价格飙升对家庭预算的影响。
随着通胀触及30年高点, 家庭预算正给人们的财务状况带来压力。
Surveying people planning to retire in 2022, Abrdn found that 66 per cent respondents proposed to continue with some form of employment beyond retiring, up from just over 50 per cent in a similar study last year and just 34 per cent in 2020.Abrdn对计划2022年退休的人进行了调查, 发现66%的受访者打算在退休后继续从事某种形式的工作, 而在去年的一项类似研究中, 这一比例略高于50%, 而在2020年, 这一比例仅为34%。
10.1192/bjp.180.3.227Access the most recent version at doi: 2002 180: 227-233The British Journal of PsychiatryROBEN DAS GUPTA and JULIAN F. GUESTAnnual cost of bipolar disorder to UK societypermissions Reprints/permissions@ write to To obtain reprints or permission to reproduce material from this paper, pleaseto this article at You can respond/cgi/eletter-submit/180/3/227 service Email alertingclick here the top right corner of the article or Receive free email alerts when new articles cite this article - sign up in the box atfrom DownloadedThe Royal College of Psychiatrists Published by on January 10, 2011/subscriptions/ go to: The British Journal of Psychiatry To subscribe toBackground The socio-economic impact of bipolar disorder in the U Kis unknown.Aims T o estimate the annual socio-economic burden imposed by bipolar disorder on U K society.Method The annual cost of resource use attributable to managing bipolar disorder was calculated.Indirect societal costs were also calculated.Results The annual National Health Service(NHS)cost of managing bipolar disorder was estimated to be»199million, of which hospital admissions accounted for 35%.The annual direct non-health-care cost was estimated to be»86million annually and the indirect societal cost was estimated to be»1770million annually. Conclusions The annual costto U K society attributable to bipolar disorder was estimated to be»2billion at1999/ 2000prices(estimated297000people withthe disorder).T en per cent ofthis cost is attributable to NHS resource use,4%to non-health-care resource use and86%to indirectcosts.Declaration of interest This study was funded by a grant from Janssen-Cilag, Saunderton,U K Bipolar disorder is a common illnesscharacterised by recurrent episodes of maniaand major depression.The lifetime preva-lence of bipolar disorder is between1%and2%(Bebbington&Ramana,1995).Moreover,bipolar disorder is often asso-ciated with other mental disorders,particu-larly alcoholism and substance misuse(Regier et al,1990).Bipolar disorder placesa substantial burden on primary andhealth-secondary health-carecare sectors as well asother statutory services(Office for NationalStatistics,1995;Onyett et al,1995);how-socio-ever,the socio-economiceconomic impact of bipolardisorder on UK society is unknown.Against this background we estimated theannual cost imposed by bipolar disorderon UK society.METHODPerspectiveThis evaluation estimated:(a)the annual costs of managing bipolardisorder from the perspective of theNational Health Service(NHS);(b)the annual costs resulting from bipolardisorder borne by other statutoryagencies,such as local authorities andthe criminal justice system;and(c)the indirect annual costs to society dueto unemployment,absenteeism fromwork and premature mortality.Primary care resource useThe DIN-link database contains infor-mation on0.9million live patients managedby approximately360general practitioners(GPs)in100nationally distributed generalpractices(using AAH Meditel System5clinical software,version5.7.x for UNIX;now System5,Torex Health,Bromsgrove,Worcestershire,UK).The database wasinterrogated to obtain the annual amountof primary care resource use(i.e.GPconsultations,GP-prescribed drugs andGP-GP-initiatedinitiated diagnostic tests)between1January1998and31December1998attri-butable to managing bipolar disorder.Patients were included if they had a noteentry of one of the following Read codes,together with an addition or amendmentto their case notes in the study year,indicat-ing that they were still registered with theirGP:hypomania/mania(E221);other manic±depressive psychoses(E22Z);affectivepsychoses(E22).The resource use estimatesderived from the DIN-link database wereextrapolated to the whole of the NHS bymultiplying by a factor of75,which takesinto account the size of the data-set popu-lation relative to that of the whole UKand the relative underrecording of certaindata items when the database is cross-refer-enced against other sources(Martin,1995).Secondary care in-patient resourceuseHospital in-patient data were based on theIBM Hospital Episode Statistics database,which contains information compiled fromthe statutory returns from the300trusts inEngland.The database was interrogated toobtain the annual number of hospital epi-sodes attributable to bipolar disorder inaccordance with the diagnostic codes ofICD±10(World Health Organization,1992)(i.e.F31.0±F31.9for1995/96to1997/98).Patients were included in thedata-set if they had a primary diagnosis ofbipolar disorder between1April1995and31March1998.Results were extrapo-lated to the whole UK by multiplying by1.2(i.e.the ratio of the population of the UK tothat of England).Other health care resource usePublished sources were used to provideinformation on resource utilisation bypsychiatric patients using NHS day hospitals(Department of Health,1999a),out-patientservices(Department of Health,1999b),community mental health teams(CMHTs;Onyett et al,1995)and special(high-security)hospitals(Department of Health,2000a,c).This was supplemented with informationobtained from interviews with ten NHSconsultant psychiatrists who had experienceof people with bipolar disorder.Personal social service resourceuse and the criminal justice systemData were obtained on resource utilisationby people with bipolar disorder using227HIB R I T I S H J O UR N A L O F P S YC H I AT RY(2002),180,227^233Annual cost of bipolar disorder to UK society ROBEN DAS GUPTA and JULIAN F.GUESTD ADA SGUP TA&GUE S Tresidential services(D.Chisholm,personal communication,1999),the criminal justice system(Stationery Office,2000a)and non-NHS day care facilities(Department of Health,1998),the latter being supplemen-ted with information obtained from tele-phone interviews with managers at seven non-NHS day care facilities. Resource costsUnit resource costs were obtained(D. Chisholm,personal communication, 1999;Netten et al,1999;Haymarket Publications,2000;Stationery Office, 2000b)and,where necessary,uprated to 1999/2000prices using the Health Service Inflation Index(Netten et al,1999).By assigning these costs to the resource use estimates,the annual direct cost attributa-ble to bipolar disorder was calculated at 1999/2000prices.Indirect resource use and costs The indirect cost arising from excess un-employment(Gareth Hill et al,1996), absenteeism from work(Lepine et al, 1997)and suicide(Sharma&Markar, 1994)among individuals with bipolar dis-order was estimated using the human capital approach(Drummond et al,1998),by applying the current annual average wage (Office for National Statistics,2000)to the estimated number of people with bipolar disorder absent from work as a result of morbidity and mortality.A6% annual discount rate was applied to the indirect costs of unemployment arising from people with bipolar disorder who commit suicide in the study year and,there-fore,who are absent from the workforce in subsequent years.Sensitivity analysisUnivariate sensitivity analyses tested the robustness of the study results to changes in resource use activity affecting health-care,non-health-care and indirect costs. RESULTSNational Health Service resource useThe DIN-link databaseThe DIN-link database contained data on 1807patients with bipolar disorder in 1998,equivalent to approximately 136000people with bipolar disorder being registered with a GP during that year.The mean age of people with bipolar disorderin the DIN-link data-set was54years.Ofthese,62%were female and38%weremale.Additionally,patients aged521years accounted for51%of the totalnumber of patients in the DIN-link data-set.GP consultationsBased on all the people with bipolardisorder in the DIN-link database,it wasestimated that there were315000GP con-attrisultations attributablebutable to bipolar disorderanduring1998.Hence,the annualnual cost ofGP consultations attributable to bipolardisorder was estimated to be£5.2million.GP-prescribed drugsFifty-eight per cent of patients in the DIN-link data-set received medication forbipolar disorder prescribed by their GPduring1998.This corresponds to an esti-mated79125patients receiving approxi-mately 1.2million GP-prescribed itemsduring the study year(Table1).TheseGP-prescribed drugs cost£8.5million.The mean annual cost of GP-prescribedmedication was£107per patient receivingmedication.This corresponds to a meanannual cost of£249per GP and£809pergeneral practice for medication for bipolardisorder.GP-initiated testsPeople with bipolar disorder undergo amean111000tests per year.These includeblood drug levels,biochemistry tests,thyroid function tests and haematology tests,costing the NHS£1.2million annually.In-patient episodesBetween1April1997and31March1998there were12400annual hospital episodesfor bipolar disorder in the UK,costing£69million.These episodes accounted for4%of the290019annual episodes for mentalhealth(Department of Health,2000a).From the interviews it was estimated thatabout30%of these episodes would resultin a patient being transported to a hospitalby ambulance,costing the NHS£670000annually.Table2summarises these data,stratified by different specialities.Table2shows that86%and10%ofepisodes are admitted to mental illness bedsand old age psychiatry beds,respectively.Furthermore,mental illness and old agepsychiatry accounted for85%and11%,respectively,of the costs of hospital carefor bipolar disorder.Forty-four per cent of the hospital-isation costs attributable to bipolar disorderwere due to patients suffering from eithermania or hypomania without psychoticsymptoms,27%to patients suffering fromdepression without psychotic symptoms,16%to those suffering from mania withpsychotic symptoms,6%to patients suffer-ing from depression with psychotic symp-toms,8%to those with a mixed episode,3%to those in remission and2%to otherbipolar disorders.The estimated mean annual number ofhospital in-patient episodes per person with228T able1Annual number and correspondingcost of g eneral practitioner-prescribed drug s for bipolar disorder Drugcateg ory Annual number(%of total)prescriptions(6103)Annual cost(%of total)prescriptions(»6103) Anti-Parkinsonians93(8%)236(3%) Anxiolytics98(8%)103(1%) Atypical antipsychotics16(1%)999(12%) Carbamazepine58(5%)234(3%) Hypnotics90(7%)285(3%) Lithium239(20%)854(10%)Non-SSRI antidepressants184(15%)1834(22%) Sodium valproate32(3%)279(3%)SSRI antidepressants128(11%)2385(28%) Thyroxine6(51%)7(51%) Typical antipsychotics268(22%)1249(15%)Total12138466SSRI,selective serotonin reuptake inhibitor.C OSANNUA L COS T OF B I P OL A R D I SOR D E R TO UK SO C I E T Ybipolar disorder was greater among the25-to34-year age group,at seven episodes per year per100patients(equivalent to almost two-thirds of all the in-patient episodes), and was seven times greater than the annual number of episodes per patient in the516-and484-year age groups.Gen-erally,the annual number of hospital in-patient episodes per patient decreased with age among patients over34years of age.Additionally,the percentage of episodes associated with manic and hypo-manic symptoms decreased with age.Con-versely,proportionally more episodes were associated with depressive symptoms as patients'age increased.Out-patient and ward attendances Approximately2million annual psychiatric out-patient attendances are conducted under the auspices of mental illness and psychiatry of old age in the UK(Depart-ment of Health,1999b),of which14% was estimated to be because of bipolar dis-order.Hence,it was estimated that a mean 277000attendances a year are attributable to bipolar disorder,costing£28.5million.There are a mean96000annual psychiatric ward attendances in the UK (Department of Health,1999b),of which 5%was estimated to be because of bipolar disorder.This suggests that there are a mean5000attendances a year attributable to bipolar disorder,costing£munity mental health team contactsThe annual cost of CMHTs in the UK wasestimated to be£380million.Fourteen percent of total CMHT contact was estimatedto be because of bipolar disorder,corresponding to an annual cost of£53.2million.NHS day hospital attendancesThere are approximately4.6million atten-dances at psychiatric day hospitals annuallyin the UK(Department of Health,1999a),of which10%was estimated to be becauseof bipolar disorder.This corresponds toabout459000attendances a year,costing£28.9million.Special hospitalsThe approximate1350beds managed bythe three high-security hospital authoritiesin the UK cost the NHS£135.2million in1999/2000(Department of Health,2000a).Based on data from a study of admissionsto one special hospital in1987/88(Gunnet al,1991),this analysis assumed that2%of in-patients are admitted because ofbipolar disorder,costing the NHS an esti-mated£2.7million in1999/2000.T otal annual NHS costThe total annual health-care cost attribut-able to managing bipolar disorder wasestimated to be£199million(Table3).Residential carePeople with bipolar disorder were esti-mated to occupy4822places in residentialaccommodation,costing£67.8million.Table4summarises these data,stratifiedby home type.Non-N HSday care attendancesThere are approximately4.7million atten-dances annually at non-NHS day care facil-ities in the UK by people with a mentalillness(Department of Health,1998),ofwhich16%was estimated to be because229T able2Annual number of hospital episodes and correspondingcosts attributable to bipolar disorderSpeciality Annual number(%of total)hospitalepisodes(6103)Annual cost(%of total)hospitalepisodes(»million)Meanlength ofstay(days)Child and adolescent psychiatry33(50.5%)0.8(1%)92Forensic psychiatry69(1%) 1.3(2%)71General medicine67(1%)0.1(50.5%)5Geriatric medicine47(50.5%)0.1(50.5%)22Learningdisability65(1%)0.5(1%)51Mental illness10652(86%)58.9(85%)38Not known160(1%)0.4(1%)15Old age psychiatry1264(10%)7.4(11%)49Total1235869.439Ambulance journeys38130.7Total annual cost of episodesplus ambulance journeys70.1T able3Annual National Health Service(NHS)costs attributable to bipolar disorderResource category Annual cost associated withbipolar disorder(»million)Percentage of annual general psychiatric NHS costHospital admissions69.4(58.9)16% Community mental health care53.214% Out-patient attendances28.514% Ward attendances0.55% Day hospital attendances28.910% GP-prescribed drugs8.551% GP consultations 5.2Unknown Special hospitals 2.72% GP-initiated tests 1.2Unknown Ambulance transport0.7UnknownTotal cost198.71.The cost in parentheses refers to the cost of admissions under the general psychiatric speciality.GP,GP,general practitioner.D A DA SGUP TA &GUE S Tof bipolar disorder.This corresponds to an estimated 754000attendances a year,cost-ing £18.1million.Criminal justice systemWe were unable to find any published evi-dence that the incidence of either imprison-ment or people on remand was higher among those with bipolar disorder than in the general population.Therefore,this analysis assumed that the cost incurred by the criminal justice system attributable specifically to bipolar disorder is zero.Indirect societal costsIndirect costs due to excess unemployment among people with bipolar disorderThe prevalence of bipolar disorder in the UK was estimated to be 0.5%(Bebbington &Ramana,1995),which is similar to the lifetime risk and annual prevalence rates and equates to approximately 297000people with bipolar disorder in the UK annually.The unemployment rate among people with bipolar disorder was estimated to be 46%,of whom 60%are available for work (Gareth Hill et al ,1996).This compared with an unemployment rate among the general population in the UK in 1999/2000of 3%(Office for National Statistics,2000).Hence,an excess of76500people annually are unemployed as a result of having bipolar disorder.Therefore,the annual indirect cost due to excess unemployment among people with bipolar disorder was estimated to be £1510million at 1999/2000prices.Indirect costs due to absenteeism from work among people with bipolar disorderThe rate of excess absenteeism from work among those with major depression com-pared with those without depression was estimated to be about 9days over a 6-month period in the UK (Lepine et al ,1997).Assuming that all of these subjects were in full-time employment,this suggests an excess absenteeism rate of 8%.By assuming comparable absenteeism from work among the UK's estimated 96300people with bipolar disorder who are employed (Kind &Sorensen,1993),the associated indirect cost would be £152million per year at 1999/2000prices.Indirect costs due to suicideThe annual incidence of bipolar disorder is0.009%and 0.0096%for males and females,respectively (Bebbington &Ramana,1995).Hence,there are 4454new cases of bipolar disorder diagnosed in the UK annually.The suicide rate among people with bipolar disorder is 1.5%annually for the first 10years following diagnosis (Sharma &Markar,1994).This equates to an excess of 640suicides because of bipolar disorder annually,with an associated indirect cost of £179million undiscounted or £109million discounted.Indirect costs due to carersA review of the published literature did not identify any evidence that there was a higher unemployment rate among carers than the general population;therefore,it was estimated that there are no indirect costs specifically attributable to carers of people with bipolar disorder.T otal annual societal cost of bipolar disorderThe total annual societal cost of bipolar disorder in 297000people was estimated to be £2055million annually (Table 5)or approximately £6919per person with bipolar disorder.Sensitivity analysesHealth care costsSensitivity analyses (Table 6)showed thatdoubling the annual number of in-patient230T able 4Residential care in the UK for people with bipolar disorderHome type Annual number (%of total)places inresidential accommodationAnnual cost (%of total)residentialaccommodation (»million)Group homes 858(18%) 6.1(9%)Low-level hostels 572(12%) 5.0(7%)Mid-level hostels 981(20%)13.8(20%)High-level hostels 1839(38%)32.7(48%)Small-scale hostels 572(12%)10.2(15%)Total482267.8T able 5T otal annual societal cost attributable tobipolar disorderResource category Cost (%of total)(»million)Direct health-care costs 199(10%)Direct non-health-care costs 86(4%)Indirect costs 1770(86%)Total societal cost2055T able 6Sensitivity analyses on National Health Service resource categoriesScenario Range of annual NHS cost(»million)Annual number of GP consultations,GP-initiated tests and GP-prescribed drugs is reduced by 50%and increased by 100%above/below baseline 191^214Annual number of hospital in-patient episodes is reduced by 50%and increased by 100%above/below baseline164^269Annual number of out-patient and ward attendances is reduced by 50%and increased by 100%above/below baseline185^227Annual number of CMHT contacts is reduced by 50%and increased by 100%above/below baseline172^252Annual number of day hospital attendances is reduced by 50%and increased by 100%above/below baseline184^228Annual number of in-patients in special hospitals is reduced by 50%and increased by 100%above/below baseline198^202GP,GP ,general practitioner;CMHT ,community mental health team.C OSANNUA L COS T OF B I P OL A R D I SOR D E R TO UK SO C I E T Yepisodes and CMHT contacts would increase the annual NHS cost of managing bipolar disorder by35%and27%,respec-tively.Conversely,halving the annual number of in-patient episodes and CMHT contacts would reduce the annual NHS cost of managing bipolar disorder by18%and 13%,respectively.However,the annual NHS cost is not sensitive to changes in the use of any other health care resource. Non-health-care direct costsSensitivity analyses(Table7)showed that doubling of the annual number of resi-dential places would increase the annual non-health-care cost of managing bipolar disorder by79%.Conversely,halving the annual number of residential places would reduce the annual non-health-care cost of managing bipolar disorder by39%.The annual non-health-care cost attributable to bipolar disorder is also sensitive to the assumptions pertaining to the use of the criminal justice system by people with bipolar disorder.If people with bipolar disorder made twice as much use of the criminal justice system as the general popu-lation,the annual non-health-care cost of managing bipolar disorder would increase by91%.Conversely,if people with bipolar disorder made half as much use of thecriminal justice system as the general popu-lation,the annual non-health-care cost ofmanaging bipolar disorder would decreaseby45%.However,the annual non-health-care cost of managing bipolar disorder isnot sensitive to changes in the annualnumber of non-NHS day care attendances.Indirect costsSensitivity analyses(Table8)showed thatdoubling of the annual number of un-employed people with bipolar disorderwould lead to an83%increase in theannual indirect cost attributable to bipolardisorder.Conversely,a50%reduction inthe annual number of unemployed peoplewould lead to a43%decrease in theannual indirect cost attributable to bipolardisorder.However,the annual indirectcost attributable to bipolar disorder isnot sensitive to changes in the excess rateof absenteeism from work or in the annualnumber of suicides.DISCUSSIONCost of illness studies provide informationabout patterns of resource use associatedwith a particular condition,therebyenabling a greater understanding of theframework in which decisions aboutresource allocation are made.However,cost of illness studies,unlike cost-effective-ness and cost utility studies,are unable todirectly inform decisions about the effec-tive allocation of resources to fund parti-cular treatments or strategies.UncertaintyIn this analysis there is considerable un-certainty surrounding the prevalence ofbipolar disorder in the UK because of thelack of robust epidemiological surveys.Community-based psychiatric surveys inother countries estimate the total preva-lence of bipolar disorder to be1.0±2.5%,which is substantially higher than the numberof people treated for bipolar disorder(Beb-bington&Ramana,1995).Also,there maybe a high level of unmet need,althoughsome patients may develop coping strategiesor endure symptoms below the thresholdsfor treatment,given the current risk±benefitratios of available drugs.Finally,the varia-tion in diagnostic threshold can contributeto the uncertainty surrounding the prevalenceof bipolar disorder(Akiskal,1996).This analysis used interviews withpsychiatrists and managers of day carefacilities to estimate the percentage of theirworkload that was associated withmanaging people with bipolar disorder.Inthe hierarchy of evidence,such expert opin-ion is the least reliable compared with,forexample,randomised control trials(Stevens&Raftery,1994),but in the absence ofrelevant published data this was the onlysuitable method with which to model theseresource items.However,the estimatedpercentage of psychiatric out-patient work-load and CMHT workload attributable tobipolar disorder was comparable to thatreported by others(Onyett et al,1995;National Health Service in Scotland,1999).The prevalence of bipolar disorderamong patients in the DIN-link databasewas about0.25%.This was comparablewith the0.5%prevalence assumed in ourstudy(Bebbington&Ramana,1995).However,some patients may be managedalmost exclusively in secondary care,whereas others may not receive any healthcare.Furthermore,some people with bi-polar disorder may have been misdiagnosedunder a Read code that was not included inthe DIN-link data-set.The estimated prev-alence of people with bipolar disorderwho attend psychiatric out-patient services231T able7Sensitivity analyses on non-health-care resource categoriesScenario Range of annualnon-health-caredirect cost(»million) Annual number of residential places is reduced by50%and increased by100%above/below baseline52^154Annual number of non-NHS day care attendances is reduced by50%and increased by100%above/below baseline77^104Use of the criminal justice system bypeople with bipolar disorder is half thatfor the general population and double that for the general population47^164T able8Sensitivity analyses on indirect costsScenario Range of annual indirectcost(»million) Annual number of unemployed people with bipolar disorder is reducedby50%and increased by100%above/below baseline1016^3280 Excess rate of absenteeism from work amongpeople with bipolar disorderis reduced by50%and increased by100%above/below baseline1695^1922Annual number of suicides attributable to bipolar disorder is reducedby50%and increased by100%above/below baseline1716^1880D ADA SGUP TA&GUE S Tis between0.12and0.24%,although the proportion of these patients in contact with their GP is unknown.SensitivityThe annual health care cost attributable to bipolar disorder is most sensitive to changes in the number of hospital admis-sions and CMHT contacts.However,there is little uncertainty about the annual num-ber of hospital admissions,which was derived from statutory Department of Health returns,although some people with bipolar disorder may have been excluded from our analysis,such as those who have only one manic episode not followed by a depressive episode.The estimated cost of CMHT contacts made use of the survey by Onyett et al(1995),which examined the organisation and operation of CMHTs in England.The structure of CMHTs may have changed since this survey was per-formed,but we were unable to find more recent published data on the structure of CMHTs to inform our analysis.Therefore, there remains some uncertainty surround-ing the cost of CMHT contacts pertaining to bipolar disorder.The annual non-health-care cost attributable to bipolar dis-order is most sensitive to changes in the number of residential places.However, there is little uncertainty about the annual number of residential places,which was derived from a database used in a study by Chisholm(D.Chisholm,personal communication,1999).The annual non-health-care cost is also sensitive to changes in the assumptions about the number of contacts made by people with bipolar dis-order with the criminal justice system.A Swiss study suggested that people with bipolar disorder were between two and three times more likely to engage in criminal activity than the general popu-lation(Modestin et al,1997).However, we found no evidence suggesting an in-creased risk of imprisonment among people with bipolar disorder in the UK.This dis-crepancy is worthy of further investigation.The annual indirect cost attributable to bipolar disorder was sensitive to changes in the number of unemployed people,which was based on a survey of those in the Manic Depression Fellowship.However,the membership of the Fellowship may not be representative of all people with bipolar disorder.The baseline indirect costs in our study relate to people receiving treatment for bipolar disorder.Including untreated cases could substantially increase the indirect costs.However,because such peoplehave not presented to the medical services,they may not exhibit the same level of mor-bidity and mortality as those who do present.Nevertheless,they may still endure reducedfunctioning and accrue costs.We estimated that640people withbipolar disorder commit suicide annually.This is equivalent to about11%of the5905suicides in the UK per year(Ray etal,1998).Additionally,in one survey of peo-ple with bipolar disorder,47%reported atleast one attempted suicide(Gareth Hill,etal,1996).In comparison,the annual numberof deaths because of depression was esti-mated to be2600(Gareth Hill et al,1996).Study limitationsPrimary care resource use was based on theDIN-link database.However,limitations indiagnostic categories may mean that somepatients included in the data-set may havebeen suffering from unipolar psychosis.Nevertheless,it was assumed that allpatients with a diagnostic code of`affectivepsychosis'suffer from bipolar disorder.Furthermore,patients with other conditions,such as schizophrenia and schizoaffectivedisorder,may have been included under thediagnostic categories for`mania and hypo-mania',reflecting the difficulties in makinga differential diagnosis for this disorder.The cost of drugs used to treat bipolardisorder constitutes less than2%of the totalcost of GP prescribing for all psychiatricconditions(Department of Health,2000d)and about5%,14%and14%of generalpsychiatric in-patient,out-patient andgeneral community team costs,respectively(Department of Health,2000d).Treatmentchoices are particularly important inpatients with bipolar disorder where com-pliance with conventional maintenancetreatment is low(Keck et al,1997).Someatypical antipsychotics have been shownto have antimanic properties(Tohen&Grundy,1999;Keck et al,2000)and a low-er risk of extrapyramidal symptoms than isassociated with typical antipsychotics(Miller et al,2001),potentially leading toimproved compliance.The cost of drugsprescribed by psychiatrists in out-patientclinics has not been included in the presentanalysis.However,because most drugs areprescribed and dispensed in the community,this is unlikely to lead to a substantial dif-ference in the annual drug cost.Moreover,the estimated annual primary care drug costof£8.5million for people with bipolardisorder is small compared,for example,with the drug costs for schizophrenia forEngland in1992/93.These were estimatedto be about£32million(£39million at1999/2000prices)(Knapp,1997).A number of services have not beencosted in this study,including a work re-habilitation scheme provided by the NHS,referrals to either a psychotherapist orclinical psychologist and attendances at adrug or alcohol dependency service.Theassociated costs of these are likely to beproportionally very low and within oursensitivity analyses.All these services areprovided within the NHS and form partof the care provided by out-patient clinics,CMHTs or day hospitals,and our baselineestimates are likely to include some of thesecosts.The analysis also excluded the intan-gible costs of patients and their families.The psychological burden of living with bi-polar disorder and its disruptive effect ondaily living affects the usual activity ofpatients and their families(Onyett et al,1995).Such activity may not involve paidemployment and is difficult to quantify.Comparison with schizophreniaCompared with schizophrenia,bipolar dis-order is a neglected disease.This is true ifone compares research output in academicjournals on the one hand and NHS plan-ning documents on the other.The presentstudy illustrates that bipolar disorder costsless than schizophrenia:£2billion com-pared with£3.7billion at1999/2000prices.In-patient care for schizophreniaaccounts for over90%of the annual directhealth care cost(£864million at1999/2000prices)(Knapp,1997),which was sub-stantially higher than the35%of theannual direct health care cost(£69million)attributable to in-patient care associatedwith bipolar disorder in our study.Allow-ing for the difference in time between thetwo studies,this difference suggests that,despite being possibly related conditions(Goodwin&Jamison,1990;Maziade et al,1995),treatment patterns differ substantially.ACKNOWLEDGEMENTSThe authors thank the following psychiatrists andmanagers of non-NHS day care centres for theircontributions to the study:Dr I.Akhter,Small HeathMental Health Unit,Birmingham;Dr C.Anderson,The Dukes Priory Hospital,Chelmsford;Dr T.Bullock,Ealing Hospital,London;Dr C.Gillespie,Newton Abbott Hospital,T orquay;ProfessorG.Goodwin,Warneford Hospital,Oxford;Professor232。
