不典型抑郁症临床误诊分析  

Analysis of Clinical Misdiagnosis of Atypical Depression

作　　者：樊伊楠 陶桂凤 孙大伟 彭龙颜 历跃 姜雨微 FAN Yi'nan;TAO Guifeng;SUN Dawei;PENG Longyan;LI Yue;JIANG Yuwei(Department of Traditional Chinese Medicine Psychology,the Third Hospital of Daqing City,Daqing,Heilongjiang 163000,China;the First Department of Adult Psychology,the Third Hospital of Daqing City,Daqing,Heilongjiang 163000,China;the Fourth Department of Psychiatry,the Third Hospital of Daqing City,Daqing,Heilongjiang 163000,China)

机构地区：[1]大庆市第三医院中医心理病区,黑龙江大庆163000 [2]大庆市第三医院成人心理一病区,黑龙江大庆163000 [3]大庆市第三医院精神四病区,黑龙江大庆163000

出　　处：《临床误诊误治》2025年第6期6-11,16,共7页Clinical Misdiagnosis & Mistherapy

基　　金：大庆市指导性科技计划项目(zdy-2023-29)。

摘　　要：目的探讨不典型抑郁症临床特点,分析误诊原因及应对策略。方法回顾性分析2020年6月至2023年6月初诊为其他精神心理或躯体疾病的10例不典型抑郁症患者的临床资料。结果10例中,4例因长期疲劳和注意力不集中被误诊为慢性疲劳综合征;3例因情绪波动和易怒被误诊为双相情感障碍;2例以胃部不适为主诉被误诊为功能性胃肠病;1例因过度睡眠及作息紊乱被误诊为睡眠障碍。所有患者在转诊至我院后,通过进一步检查确诊为不典型抑郁症。误诊时间1~3个月。确诊后患者接受个体化对症治疗,6个月随访显示9例症状改善,1例在治疗初期症状缓解不明显,经药物调整后改善。结论不典型抑郁症临床表现复杂且多样,易与其他精神及躯体疾病混淆;提高对其特征性症状的认识,结合标准化心理量表及多学科协作,有助于降低误诊率,提高诊断准确性。Objective To investigate the clinical characteristics of atypical depression,and to analyze the causes of misdiagnosis and countermeasures.Methods From June 2020 to June 2023,the clinical data of 10 patients with atypical depression who were initially diagnosed with other mental,psychological or physical diseases were retrospectively analyzed.Results Among the 10 patients,4 patients were misdiagnosed as chronic fatigue syndrome due to long-term fatigue and inattention.Three patients were misdiagnosed as bipolar disorder due to mood swings and irritability.Two patients with stomach discomfort as the main complaint were misdiagnosed as functional gastrointestinal disease.One patient was misdiagnosed as sleep disorder due to excessive sleep and sleep disturbance.After referral to the Department of Psychology,all patients were diagnosed with atypical depression through further examination.The duration of misdiagnosis was 1-3 months.After diagnosis,the patients received individualized symptomatic treatment,and the 6-month follow-up showed that the symptoms of 9 patients improved significantly,and 1 patient had no obvious relief in the early stage of treatment,but significantly improved after drug adjustment.Conclusion The clinical manifestations of atypical depression are complex and varied,which are easily confused with other mental and physical diseases.To improve the understanding of the characteristic symptoms,combined with standardized psychological scale and multidisciplinary collaboration,is helpful to reduce the misdiagnosis rate and improve the diagnostic accuracy.

关 键 词：不典型抑郁症 误诊 疲劳综合征 慢性 双相情感障碍 功能性胃肠病 睡眠障碍 抑郁自评量表 汉密尔顿抑郁量表 

分 类 号：R749.41[医药卫生—神经病学与精神病学]