I. When it comes to emotion, it refers to the individual’s inner experience and attitude toward the real environment and objective things.
It is presented in the interaction between the individual and the environment. In psychology, it is different from emotion, which is mainly associated with the physiological activities of the body, accompanied by obvious autonomic reactions of the more primary internal experience, such as pain from bruises, pale face, watching a performance to feel happy, nervous sweat during the examination, laughing to belly pain, etc.. They are short-lived and contextual in nature (translated as emotion in English). Emotion, on the other hand, is an advanced inner experience associated with psychosocial activities (translated as effect), such as sincere friendship between two people, passionate love, aesthetic sense, moral sense, etc. It is not only situational, but also has a sense of aesthetics and morality. It is not only situational, but also long-term and stable. We speak of state of mind, on the other hand, as an enduring emotional state (translated in English as mood) that affects an individual’s inner experience and behavior. In the psychiatric clinic, these three terms are commonly used from time to time, and we do not make a careful distinction between them.
Second, in China affective disorders are mental disorders characterized by changes in emotion and state of mind, and usually have three forms of expression.
(1) changes in the nature of emotion, such as high emotion, low emotion, anxiety, fear.
(2) Changes in the fluctuating nature of emotions, including irritability, emotional instability, and emotional indifference.
(3) changes in the coordination of emotions, including emotional inversion, emotional naivete, contradictory emotions, etc. There are actually many great works of ancient poetry that describe emotions meticulously. For example, the great poet Zhang Ji of the Tang Dynasty wrote “Night at the Maple Bridge”. When he wrote this poem, he had already entered the capital six times and failed repeatedly, so he was depressed and could not stand it. It is difficult to fall asleep). The poem is a realistic description of the depressed state of mind at that time. The poet Li Bai was exiled to Yelang in the second year of the Qian Yuan era of Emperor Su of Tang Dynasty, and when he arrived at the city of Baidi, he was suddenly pardoned, so he was overjoyed and wrote, “I resigned from the city of Baidi in the morning, showing my high emotion at that time. (so happy). These help us to have a clear perceptual understanding of emotions.
Third, the diagnosis of affective disorders of the three major systems DSM — IV system, ICD10 system, CCMD — III. The classification of bipolar disorder, DSM — Ⅳ is divided into.
(a) Bipolar I (including single episode and recurrent manic episodes) Bipolar II
(II) cyclothymic disorder
(III) bipolar disorder not specifically referred to in it, including rapid cyclic episodes, recurrent light manic episodes, ICD: including single episodes and recurrent manic episodes. Not divided into biphasic type I and type II, but in other bipolar disorders, including biphasic type II. Rapid cyclic episodes are not listed, and persistent mood disorder includes mood disorder. ccmd-III single and recurrent mania is listed as a subtype, which is not a bidirectional disorder. Cyclic episodes are listed in biphasic disorder, but biphasic type II is not listed.
Fourth, what is biphasic type II? It refers to the predominantly depressive episode accompanied by one or more manic episodes. “DSM-IV (1994) diagnostic criteria: divided into core symptoms, additional symptoms, the shortest duration, etc.. Define him specifically as: A: light mania is a continuous euphoric irritable state, this state lasts at least four days. B: the presence of three or more additional symptoms (if only irritable, at least four additional symptoms are required) [additional symptoms are the following.
1.Overestimation or exaggeration of self
2. Reduced need for sleep (sleep well after only 3 hours)
3, more talkative than usual or feel the urgency to talk all the time
4. Drifting thoughts or subjective experience of racing thoughts
5.Shifting with the situation and easily distracted.
6.Increased purposeful activity (whether social, work, study or sexual activities are so), or psychomotor excitement
7, excessive participation in certain fun activities that have the potential to cause painful consequences of pleasure (such as uncontrolled binge drinking, reckless sexual behavior, or foolish business ventures, etc.)]; C: no impairment of social function, D: other people can observe abnormal changes, E: the symptoms do not meet the diagnostic criteria of mania. f: exclude psychoactive drugs known as seminal psychiatric disorder.
Its clinical features compared with one-way depression are
(1)Early age of onset.
(2)High relapse rate.
(3)More atypical symptoms.
(4) More common in females. Epidemiological data, the National Institute of Mental Health (NIMH), fansson (2003) and other surveys, the lifetime prevalence of bipolar II disorder 0, 5-3, 0%, outpatients with depression in bipolar II disorder accounted for 30-50%, higher than Lepine et al. (2003) reported bipolar Type I affective disorder lifetime prevalence 0,01-1,7%. The rapid cycling type accounts for about 7,9% of mood disorders and occurs more often in bipolar II disorders, accounting for about 75-83,5%. New trends in the diagnosis of biphasic type II disorders focus on the three aspects of minimum duration, core symptoms and additional symptoms. The minimum duration of DSM-III DSM-III-R is not specified, and DSM-IV is only set at 4 days, and less than 4 days is classified as unclassified bipolar disorder. Angst even proposed 1-3 days after the famous Zurich trial, because compared to 4-5 days, there was no significant difference in the diagnosis and treatment of depression in terms of family history, age of onset, suicidal intent comorbidity, etc., after a one-year prospective study, in addition to the total time of experiencing hypomania longer than the former. In the past, “euphoria and irritability” were considered as the core symptoms, but because hypomania rarely complains because of high energy, active activity, and reduced need for sleep, it is easy to miss the diagnosis by asking patients about their mood changes alone. “should be the core symptom because the manifestations of hyperactivity are easily asked and recalled by the patient’s family, (e.g., high energy, active, increased behavior, going back and forth, busy, reduced need for sleep, fatigue deficit, etc.). It is even considered that additional symptoms such as three items can be diagnosed as light mania.
For the treatment of bipolar II affective disorder, the American Psychiatric Association proposes that the principle of bipolar II treatment is an antidepressant plus a mood stabilizer. In the past, most drugs such as lithium carbonate, carbamazepine, and sodium valproate were used in combination with antidepressants. In patients treated with lithium carbonate 25-30% withdrew from treatment due to side effects, more than 50% had poor compliance and for rapid cycling type and mixed state, but 20-30% were ineffective with lithium salts. Sodium valproate is one of the better traditional drugs and has good efficacy for rapid cycling, which has been confirmed in many studies. And traditional antidepressant treatment can increase the rate of transient mania and increase the cycling frequency, according to Gane et al. (2004) reported that BP-D transient mania with ADS alone (combined with MSs is a decrease of 31,5%), cycling frequency increased by 25,6%, and the new occurrence of RC was 32,1%.
The results of recent studies have shown that there are a variety of drugs available to stabilize the state of mind and to assist in the treatment of bipolar disorder in two main categories.
(1) new antiepileptic drugs, gabapentin, lamotrigine and topiramate have been used in succession, with lamotrigine having the most pronounced effect. The dose in daily see adverse reactions as drowsiness, tremor, headache, taste, etc.. It should be noted that it can occur a called syndrome, an allergic erythema, which can involve the skin mucosa and heart muscle, with a potentially fatal risk of its incidence. Topiramate has a weight-reducing effect on patients with weight gain, day, with a faster onset of action. Their mechanism of action is thought to be probably through stimulation of receptors or inhibition of metabolism or reuptake, thereby increasing the activity or inhibiting the excitatory brain transmitter glutamate activity, calcium ion antagonism Class II: atypical antipsychotics. Clozapine has been used in bipolar disorders, especially in some refractory manias. Vistone has more research in this area, the dose in the day, whether alone or combined application have better effect, some studies think that it is better for the depressive symptoms prominent mood stabilization, while some think he is better for the manic prominent mood stabilization, but the former is reported more.
(2) Olanzapine is mostly used in combination, such as lithium carbonate or fluoxetine, and the dosage is more often used for bipolar disorder with prominent manic symptoms. Common sleepiness dry mouth weight gain. Quidipine research is more focused on bipolar disorder with depression, dose day preliminary application proved to be more effective, the above effects are believed to be related to blocking dopamine and pentraxin receptors. Anti-agent applications were more prevalent around 1980, but were most often applied as maintenance therapy. The mechanism is that studies have found increased calcium in-flow in patients with rapid cycling and that calcium antagonists can reduce calcium in-flow. Antidepressant treatment for bipolar disorder is now mostly preferred to the application of new antidepressants, such as SSRIs, with venlafaxine and mirtazapine conversion rates considered to be dose-related but overall higher than SSRIs (studies on vs. paroxetine). The combination of two antidepressants should be avoided as much as possible during application to reduce transient agitation and increase cycling frequency.