A mixed state core for melancholia: an exploration in history, art and clinical science
A mixed state core for melancholia: an exploration in history, art and clinical science
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DOI：
10.1111/j.1600-0447.2007.00962.x
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发表时间：
2007-01-01
影响因子：
6.7
通讯作者：
Akiskal, K. K.
中科院分区：
文献类型：
--
作者：
Akiskal, H. S.;Akiskal, K. K.
目的：我们用艺术、历史和科学文献中的例子来比较几个世纪以来忧郁症的概念，我们认为忧郁症是一个混合状态核心。方法：文献综述侧重于从Kraepelin开始的研究，DSM-IV分类和来自临床经验的观点，强调现象学和生物学特征作为抑郁症前瞻性研究中双相结果的预测因素。结果：尽管内源性/忧郁性抑郁症一词隐含着化学病理，经常报告糖皮质和睡眠神经生理学异常，但几乎没有证据表明忧郁症独立于更广泛定义的抑郁症。对神经症性抑郁症的前瞻性随访显示，多达三分之一的人出现了忧郁的结果；在这样的随访中也观察到了轻度躁狂。结论：这些发现和考虑总体上确实表明，今天定义的忧郁症与双相情感障碍的抑郁和/或混合期更接近。考虑到其中许多患者的高自杀率，使用抗抑郁药物单一疗法治疗他们的做法需要重新评估。
Objective: We argue for a mixed state core for melancholia comparing concepts of melancholia across centuries using examples from art, history and scientific literature.Method: Literature reviews focusing on studies from Kraepelin onward, DSM-IV classification and view-points from clinical experience highlighting phenomenologic and biologic features as predictors of bipolar outcome in prospective studies of depression.Results: Despite the implied chemical pathology in the term endogenous/melancholic depression, frequently reported glucocortical and sleep neurophysiologic abnormalities, there is little evidence that melancholia is inherited independently from more broadly defined depressions. Prospective follow-up of 'neurotic' depressions have shown melancholic outcomes in as many as a third; hypomania has also been observed in such follow-up.Conclusion: These findings and considerations overall do suggest that melancholia as defined today is more closely aligned with the depressive and/or mixed phase of bipolar disorder. Given the high suicidality from many of these patients the practice of treating them with antidepressant monotherapy needs re-evaluation.