《我们的天才儿子》一文近日在全网刷屏。从小说、电影,到音乐、哲学,译者金晓宇的故事令无数读者动容,也让不少人注意到这位被唤作“天才”的译者从青年时就被确诊的一种精神疾病——双相情感障碍。双相情感障碍和抑郁症有什么区别?双相情感障碍的患者都是“天才”吗?扬子晚报/紫牛新闻记者就这些问题采访了南京脑科医院心境障碍科主任医师王纯。

  扬子晚报/紫牛新闻见习记者 吕彦霖

  “轰隆一声巨响,晓宇把厨房的冰箱推倒了。这是他第一次出现暴力行为。”“晓宇睡在床上怎么也叫不醒,他妈发现他是吃了安眠药自杀。”在近日刷屏全网的《我们的天才儿子》一文中,“天才”译者金晓宇的症状被这样描述,并且很快他就被确诊为一种名叫躁狂抑郁症,也叫双相情感障碍的精神类疾病。

  疑问1

  双相情感障碍与抑郁症有什么区别?

  南京脑科医院心境障碍科主任医师王纯告诉记者,这正是该疾病典型的症状,“一方面,患者会有心境的低落,不开心、动力和兴趣降低、悲观的类似抑郁症的表现且这样的时候还挺多的。但同时也会有恰好相反的表现,躁狂的时候就会兴奋话多、精力旺盛、自大、冲动、易激惹等。”

  有人把金晓宇看作“天才”译者,也有人列举贝多芬、梵高、牛顿、丘吉尔、海明威等历史名人所出现的双相情感障碍的典型表现。但在王纯看来,所谓的“天才”可能更多的是患者在躁狂发作期时思维敏捷和精力旺盛,也可能因患者对情感反应的敏感和深刻,使其在一定程度上有更深的艺术感受力和感染力,如果病情不重,反而有助于某些领域的表现。

  "But the genius here is in quotation marks," Wang Chun pointed out, because the increase of energy and brain power in hypomania is a disease state. This state is uncontrollable, unlasting, and unattainable, and it often appears deeper after mania. Longer depression, after repeated episodes, will also have a persistent impact on cognitive functions such as memory and attention.

Moreover, in addition to the rapid progress of thinking in work and study, patients may also appear reckless and reckless in different degrees, spend money recklessly, invest recklessly, lose their temper easily, become irritable over trivial matters, and have a high chance of arguing with others. In some cases, there may be situations such as impulsive beating.

  The latest large-scale epidemiological data in my country shows that the incidence of depression in the population is generally around 3.59%, while the incidence of bipolar disorder is around 0.46%.

"Among mental illnesses, bipolar disorder and depression, which has been gaining more and more attention in recent years, belong to the same spectrum, but the nature of bipolar disorder is closer to schizophrenia and more severe than depression. And these diseases have more to do with genetics and biology."

  Question 2

  What are the causes of bipolar disorder?

  Regrettably, the cause of mental illness is not so clear at present.

"What is certain is that it must be related to genetics. There may be thousands of genes related to mental illness. Bipolar disorder is also a manifestation of polygenic influence. At present, the proportion of genetic factors in the cause of the disease is in More than 70%, and less than 30% of the factors are due to social psychological factors and growth experience," Wang Chun further explained.

  This also means that, on the one hand, current medical technology cannot completely control disease-causing genes to bring targeted therapy.

On the other hand, if the potential patients with the disease can be provided with positive social and psychological guidance, it can have a certain preventive effect.

"If a person has a genetic risk of bipolar, but does not have the disease, then he will be fine for life. But if there are some people who are more 'unlucky', he has a genetic risk, and his upbringing experience and family environment are not good. Having had a major setback and so on that caused him to get sick, then the lives of these two patients are completely different."

  Question 3

  Can it be cured by drug intervention?

  那么若是身边有人罹患双相情感障碍,或者有这种疾病的倾向,作为身边的人可以做什么?王纯指出,身边人尤其是父母亲属为孩子提供一个温暖、陪伴、开放、积极的生活环境,而非充满了压力、被忽视、受虐待等等不好的家庭和成长因素的环境,对患者或是潜在患者来说相当重要。“一来这样的环境不太容易导致发病,另外即使是发作期若能有这样的一个环境的支持,也更利于康复,同时减少复发的机会。”

  双相情感障碍症状与抑郁症不同,干预方法也大相径庭。王纯表示,由于七成左右的致病原因是生物学素质,目前对于双相情感障碍的治疗也以药物治疗为主,心理干预为辅。“双相情感障碍的心理干预更多在于如何保证服药依从性,怎样能够及时地识别症状、及早地就医,还包括如何预防复发,以及怎样解决患者的人际和生活困难等等。其实心理干预的目的更多的是对其进行支持,而不是单纯治疗疾病本身,但这对减少复发、促进康复和生活质量有重要的作用。”

  王纯告诉记者,就“临床治愈”而言,双相情感障碍症状控制并不困难,只要遵医嘱吃药有超过80%的患者可以控制症状。

  不过,若是完全不吃药还想达到不发作的“彻底治愈”状态则尚有难度,“我们的药物可以控制症状,并不能够改变致病的遗传基因,所以双相情感障碍也是个慢性疾病,需要很长时间通过药物持续状态,在相当长时间之后,患者的生物学内环境获得长期的稳定才能够在医生指导下渐渐减药,也有些患者可以做到完全治愈不再复发”,王纯说。

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