Bipolar disorder-Bipolar disorder is characterized by obvious disorder of mood and activity level with two or more episodes. At least 1 time is characterized by high mood, increased energy and activity, and other 1 time is characterized by low mood, decreased energy and decreased activity. See: depression; Hypomania; Manic. Emotional disorder has been renamed as mood disorder abroad in recent years, which is mainly manifested as high (mania) or low (depression) mood, or both appear alternately. People with severe emotional disorders are called affective psychosis. Diagnostic points 1. High mood, irritability or depression, or bipolar. Second, depressed people, from mild pessimism to strong sense of guilt. Third, thinking difficulties, lack of decision, lack of interest. Fourth, headache, sleep disorder and lack of energy. 5. Anxiety. In severe cases, there may be bradykinesia, agitation, hypochondriasis or delusions of victimization, anorexia, insomnia, etc. Diagnostic criteria (revised edition of Chinese Medical Association, 1984, 10) 1. Manic episode (1) symptom standard 1. The main symptoms are high mood and/or irritability, and they are relatively persistent. 2. For the first time, the author's emotional disorder has lasted for at least 2 weeks (unless the symptoms are serious enough to require hospitalization or the author who has had manic or depressive symptoms in the past), and there are at least the following four symptoms (if the mood is only irritating; You need to have five things): ① Talk more than usual, or talk endlessly. Pet-name ruby thoughts wander, thinking fled. 2 inattention, shifting with the environment. 4 conceit, self-evaluation is too high. ⑤ Feel good about yourself: feel flexible, especially strong or energetic. ⑥ The need for sleep is reduced. ⑦ Increased activities (including work, daily activities, social activities and sexual behavior). 8 reckless and willful, reckless. (2) The severity standard clinical symptoms must reach one of the following severity levels: 1. There is no effective dialogue. 2. Social ability (work, study, social or housework ability) is obviously impaired. 3. Need immediate treatment or hospitalization. 4. Have symptoms of mental illness. (3) Exclusion criteria 1. When the emotional symptoms subside, the following symptoms continue to exist: ① delusions and hallucinations that are incompatible with emotions. 2 weird behavior. ② "first-degree symptoms". ④ Tension symptom group. 2. Schizophrenia and other diseases also have emotional symptoms. 3. Emotional symptoms are caused by drugs, poisoning or other organic reasons. 2. Symptomatic criteria of depressive episode (1) 1. The main symptoms are depression; And it lasts longer, but there can be a rhythmic change in the morning and light at night. 2. For the first time, the author has suffered from emotional disorder for at least 2 weeks (if the symptoms are serious, he needs immediate treatment or hospitalization, or the author must have had symptoms of mania or depression in the past), and has at least the following four symptoms: ① Loss of interest or pleasure in daily activities, and decreased sexual desire. (2) the energy is obviously weakened, and there is no reason for fatigue and weakness. ③ Repeated thoughts of death, or suicidal attempts or behaviors. (4) Regret or guilt. ⑤ Decreased thinking ability or attention. 8. Mental retardation or agitation. ⑦ Insomnia, early awakening or excessive sleep. 8 loss of appetite and obvious weight loss. (2) The severity standard clinical symptoms must reach one of the following severity levels: 1. Social skills are obviously impaired. 2. Need immediate treatment or hospitalization. 3. Have symptoms of mental illness. (3) The exclusion criteria are the same as item (3) in the manic episode criteria. Third, the diagnostic criteria of bipolar disorder meet one of the following two items: ① manic episode in the past, this time the author of depression; ② I had a depressive episode before, but this time I was manic. [Edit this paragraph] Drug treatment of bipolar disorder (1) Principles of drug treatment 1. First, use the safest and most effective drugs, mainly mood stabilizers. 2. According to the needs of the disease, there are two ways to combine drugs in time: mood stabilizer plus antipsychotics or benzodiazepines, mood stabilizer plus antidepressants. It is necessary to understand the drug interaction caused by the induction or inhibition of metabolic enzymes when combined with drugs. 3. Regularly monitor the blood drug concentration to evaluate the curative effect and adverse reactions. Because the therapeutic index of lithium salt is low and the therapeutic dose is close to the toxic dose, the blood lithium concentration should be monitored dynamically. Carbamazepine or sodium valproate should also reach the level of antiepileptic blood concentration in the treatment of mania. According to the determination of blood concentration, the blood collection time should be 12 hours after the last medication (for example, the next morning). 4. If one medicine is ineffective, you can change it to another medicine or add another medicine. To judge the ineffectiveness of an emotional stabilizer, factors such as poor compliance and low blood concentration should be excluded, and the medication time should be more than 3 weeks. If the above factors are still ineffective, you can replace or add another emotional stabilizer. (2) Emotional stabilizer 1, common emotional stabilizer: (1) lithium carbonate (2) valproate (3) carbamazepine 2, candidate emotional stabilizer: (1) lamotriazine (2) topiramate (3) gabapentin (4) second-generation antipsychotics. If the lithium salt is ineffective immediately, choose sodium valproate or carbamazepine, or add sodium valproate or carbamazepine to the lithium salt. If you can't tolerate lithium therapy, choose sodium valproate or carbamazepine. For fast riding or mixed exercise, because of its unsatisfactory response to lithium salt, sodium valproate or carbamazepine, or a combination of candidate mood stabilizers, should be preferred. For bipolar depression, lamotrigine can be the first choice, and short-term antidepressants can be combined if necessary. For refractory cases, lithium salt can be combined with sodium valproate or carbamazepine. If it is still ineffective, candidate mood stabilizers can be added on the basis of the original treatment, or effect enhancers can be added according to the situation. 3. benzodiazepines: chlorhexidine and clonazepam. 4. First-generation antipsychotics: For the authors with acute mania or mixed seizures with excitement, irritability, aggression or psychotic symptoms, and the authors with psychotic symptoms, mood stabilizers and first-generation antipsychotics can also be used in the early stage of treatment for a short period of time. 5. Patients with refractory bipolar disorder, especially patients with refractory rapid cycle attacks, were treated with synergist and drugs, and candidate mood stabilizers, calcium channel antagonists (verapamil 80- 1.20 mg/d, twice a day, nimodipine 40-90mg /d, twice a day) and thyroid hormones (T325-53 times a day). 6. The use of antidepressants in bipolar disorder In the treatment of bipolar disorder, the use of antidepressants may induce manic or hypomanic episodes, or increase the circulation frequency, or trigger rapid circulatory episodes, thus making the treatment more difficult. Therefore, antidepressants should be used with caution when bipolar disorder occurs. If the symptoms of depression are serious and last for more than 4 weeks, and depression is the main clinical phase in the past, antidepressants can be used on the premise of making full use of emotional stabilizers. Generally, butylamine phenylacetone without manic effect can be selected first, followed by 5-HT reuptake inhibitor, and TCAs with strong manic effect should not be selected as far as possible. [Edit this paragraph] Book Information Title: "Bipolar Disorder" Author: (America) Mike Lowitz, translated by Chen Youtang Publishing House: Chongqing University Press Publishing Time: 2010-1ISBN: 97875624521kloc-0/9 folio. This book introduces the etiology, treatment and self-management of bipolar disorder, and provides effective treatment and self-management tools to avoid extreme emotional confusion and huge money loss caused by the disease and maintain a colorful emotional experience. About the author Dr. David Miklovitz is a professor of psychology at the University of Colorado. A leader and clinical expert in the research field of bipolar disorder. His book Dry Depression: Family-centered Treatment, co-authored with Michael Goldstein, won the Outstanding Publication Award of the American Association for Marriage and Family Therapy (1988). He also won the Outstanding Researcher Award (200 1) from the National Research Alliance for Schizophrenia and Depression. He has published many papers in British Journal of Psychiatry, Journal of Neurology and Psychiatry, Physical Psychiatry, Journal of Counseling Psychology and Clinical Psychology, and Abnormal Psychology.