LONGITUDINAL COURSE OF AFFECTIVE ILLNESS--IMPLICATIONS FOR UNDERLYING MECHANISMS

已经开发出方法来系统地评估和绘制 情感性疾病的纵向病程与药理学的关系 干预和心理社会压力源。我们已经描述了一个过程 在172多名患有这种疾病的患者中系统地患病 原发情感障碍。这些数据重新记录了早期的观察结果 这一过程往往不仅是一个反复，而且是一个渐进的过程 骑自行车的频率和疾病严重程度的增加。它是反对的 在这种背景下，必须考虑药物干预。我们有 注意到之前对双相情感障碍的传统干预措施之一 抑郁症，三环类抗抑郁药，似乎有35%的风险 导致明确的或可能的转变为狂热。在那些 证明了这种诱导，我们已经观察到了一种模式，即 在NIMH入院前一年骑自行车，住院时间较长 NIMH，表明TCA诱导的开关至少是一个标志 恶性病程。锂的一种新现象 已经描述了由停药引起的不稳定，呈现出一种 继续接受长期维持治疗的患者的其他理由 治疗。当然，我们已经开始评估神经生物学的相关性。 疾病使用各种神经递质和内分泌标志物。在……里面 在长时间的非药物评估后，我们对患者进行了研究 已经观察到快速循环者的T4和游离T4明显更高 与非快速循环者相比。这些数据与以前的相反。 服药患者的观念，其中快速自行车经常被联系在一起 患有甲状腺功能减退症。在躁郁症患者中，更致命的自杀企图 与单相相比，似乎发生在病程较晚的阶段 这些通常发生在第一次发作之后的患者。

Methods have been developed to systematically assess and plot the longitudinal course of affective illness in relationship to pharmacological interventions and psychosocial stressors. We have characterized a course of illness systematically in this fashion in more than 172 patients with primary affective disorders. These data re-document the early observations that the course is often not only one of recurrences, but of progressive increases in frequency of cycling and severity of illness. It is against this backdrop that pharmacological intervention must be considered. We have noted that one of the previous traditional interventions for bipolar depression, tricyclic antidepressants, appear to carry a 35% risk of causing definite or likely switches into mania. In those individuals who show this induction, we have observed a pattern of increased rapidity of cycling in the year prior to NIMH admission and longer hospital stays at NIMH, suggesting that TCA-induced switches are at least a marker for malignant course of illness. A new phenomenon of lithium discontinuation-induced refractoriness has been described that presents an additional rationale for continuing patients on long-term maintenance treatment. We have begun to assess neurobiological correlates of course of illness using a variety of neurotransmitter and endocrine markers. In patients studied after a prolonged period of medication-free evaluation, we have observed that rapid cyclers show significantly higher T4 and free T4 levels compared with non-rapid cyclers. These data are contrary to previous notions in medicated patients, where rapid cycling was often associated with hypothyroidism. In bipolar patients, more lethal suicide attempts appear to occur later in the course of illness in contrast with unipolar patients where these often occur after the first episode.