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ENGLISH ABSTRACT
伴非典型特征抑郁症的临床评估与诊治指导建议
中华医学会精神医学分会抑郁障碍研究协作组
作者及单位信息
·
DOI： 10.3760/cma.j.cn113661-20201127-00484
Recommendations of clinical evaluation, diagnosis, and treatment for patients of major depressive disorder with atypical features
Chinese Academy of Depressive Disorders, Chinese Society of Psychiatry
Fang Yiru
Li Lingjiang
Authors Info & Affiliations
Chinese Academy of Depressive Disorders, Chinese Society of Psychiatry
Fang Yiru
Li Lingjiang
·
DOI： 10.3760/cma.j.cn113661-20201127-00484
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摘要

非典型特征是抑郁症常见的临床伴随特征之一，这类患者具有起病早、病程长、共病率高、预后差、转相风险大、自杀风险高等特点。然而，目前临床实践中对伴非典型特征的抑郁症缺乏认识，针对其临床评估、诊断及治疗等方面尚未形成基于循证证据的指南或共识。鉴于此，中华医学会精神医学分会抑郁障碍研究协作组专家们立足临床实践需求，遵循循证医学证据，参考国内外指南，提出针对伴非典型特征的抑郁症的临床评估与诊治建议，以期为精神卫生工作者提供参考。

抑郁症;诊断;治疗;非典型特征
ABSTRACT

Atypical features are among the most common subtype features of major depressive disorder (MDD), characterized by early-onset, longer illness duration, higher comorbidity, higher risk of switching to bipolar disorder and higher risk of suicide as well. However, there is a lack of awareness of depression with atypical features in clinical practice, and no evidence-based guidelines or consensus have been formed for its clinical evaluation, diagnosis, and treatment. Experts of the Academy of Depressive Disorders in Chinese Society of Psychiatry, based on the needs of clinical practice, following evidence-based medicine evidence and domestic and foreign guidelines, propose clinical evaluation, diagnosis and treatment recommendations for depression with atypical features, and provide reference for mental health proffessionals.

Depressive disorder;Diagnosis;Therapy;Atypical feature
Fang Yiru, Email: mocdef.nabuyilagnafuriy
Li Lingjiang, Email: mocdef.3ab610292jll
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引用本文

中华医学会精神医学分会抑郁障碍研究协作组. 伴非典型特征抑郁症的临床评估与诊治指导建议[J]. 中华精神科杂志,2021,54(02)：87-95.

DOI:10.3760/cma.j.cn113661-20201127-00484

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抑郁症（major depressive disorder）具有异质性，美国精神障碍诊断与统计手册第5版（Diagnostic and Statistical Manual of Mental Disorders， Fifth Edition， DSM-5）对抑郁症标注了8个不同的临床特征 ［ 1 ］ ，其中，伴非典型特征的抑郁症因难以识别、治疗困难和预后不良为众多研究者所关注 ［ 2 , 3 , 4 ］ 。非典型特征是抑郁症常常伴随的临床特征之一，占抑郁症总体人群的15%~50% ［ 5 , 6 , 7 ］ ，我国最新数据显示非典型特征在抑郁症患者中占比为15.3% ［ 8 ］ 。患者起病阶段个性发育尚未成熟，临床表现不典型，典型抑郁发作常见的生物学症状如失眠、食欲下降往往颠覆为贪睡、暴食和体重增加，情绪反应性强烈，因而导致临床难以识别 ［ 2 ］ 。伴非典型特征的抑郁症具有起病年龄早、病程冗长、共病率高、自杀风险高等特点 ［ 3 ， 5 ， 8 ］ ，尤其是对常规抗抑郁治疗反应较差、转躁风险高 ［ 4 , 5 ］ ，其预后转归不定。
不同临床特征抑郁症的病理机制不尽相同，治疗反应也有差异。基于临床特征的抑郁症“亚型”“特征”分类，有利于结合患者的临床特征来优化治疗方案，进而实现抑郁症的“个体化治疗” ［ 5 ］ 。目前，临床上对非典型特征的认识不足，对其诊断归类、治疗方案等方面尚未达成共识。鉴于此，中华医学会精神医学分会抑郁障碍研究协作组组织业内专家立足临床实践，在综合评价近年国内外相关文献的基础上，参考国内外指南 ［ 9 , 10 , 11 , 12 , 13 , 14 , 15 ］ ，提出针对伴非典型特征的抑郁症的评估与诊治建议。
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备注信息
A
方贻儒，Email： mocdef.nabuyilagnafuriy
B
李凌江，Email： mocdef.3ab610292jll
C

中华医学会精神医学分会抑郁障碍研究协作组. 伴非典型特征抑郁症的临床评估与诊治指导建议[J]. 中华精神科杂志, 2021, 54(2): 87-95. DOI: 10.3760/cma.j.cn113661-20201127-00484.

D
所有作者均声明不存在利益冲突
E
国家重点研发计划“重大慢病重点专项”项目 (2016YFC1307100)
国家自然科学基金重点项目 (81930033，81771465)
上海市精神卫生中心临床研究中心项目 (CRC2018ZD05)
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