 精神病在一些國家被視為恥辱。 |
醫學雜誌《柳葉刀》發表的最新研究顯示，精神病患者在發展中國家往往受到忽略。
這些科學家說在全球病症中，精神病佔了14%，比癌症或心臟病還要多。
每年有80萬名精神病患者自殺，其中主要是來自貧窮國家的人口。
除此以外，這些科學家發現在發展中國家，有90%的精神病患者沒有得到照料，有些人還被綁在樹旁或被關在籠子裡。
負責健康的官員在《柳葉刀》說發展中國家需要新方法和更多的金錢來處理精神病問題。
他們警告更多人因為戰爭、貧窮和疾病的關係而受到精神病困擾，如果這個問題得不到妥善處理，貧窮國家將會繼續受苦。
缺乏處理
一個在印度為精神病者爭取權益的組織對美聯社說，估計在印度患上精神分裂、憂鬱病、強迫性神經症和焦慮病的4000萬至5000萬名精神病者中，只有7%至8%能夠得到適當照料。
巴西主要城市的街角不時會發現一些成年精神病患者行乞或在高速路底下睡覺。
貧窮農村社會的貧窮家庭都希望可以好好照料受到精神病困擾的家人，但往往無法負擔醫療費或特別照料。
精神病在一些國家被視為恥辱。
贊比亞視精神病為巫術或被魔鬼上身，患者都不願意求助。
精神病威脅生命，每年便有80萬名精神病患者自殺。
5個精神病患者中，有4個是來自低收入或中收入國家。
缺乏資源
報告也強調精神病對其他健康狀況的影響。
精神狀態不佳會令人更容易受到其他健康問題的困擾，而病患者更可能得不到他們需要的醫療照顧、社會支援和照料。
他們的家人也同樣受到困擾，印度和巴基斯坦都發現患了憂鬱症的媽媽極可能懷有營養不良的孩子。
面對著缺乏資源的困難，貧窮國家在處理精神病患者時往往束手無策。
但不少專家認為如果把精神病列為普通醫療服務的一部份，便可以提供便宜和簡單的基本精神病健康服務。
Bipolar Illness Soars as a Diagnosis for the Young
Brit Simons, 15, and his mother with pets. Drugs have tempered his outbursts, Ms. Simons said, and he is an honor roll student.
The number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, researchers report today in the most comprehensive study of the controversial diagnosis.
Experts say the number has almost certainly risen further since 2003.
Many experts theorize that the jump reflects that doctors are more aggressively applying the diagnosis to children, and not that the incidence of the disorder has increased.
But the magnitude of the increase surprises many psychiatrists. They say it is likely to intensify the debate over the validity of the diagnosis, which has shaken child psychiatry.
Bipolar disorder is characterized by extreme mood swings. Until relatively recently, it was thought to emerge almost exclusively in adulthood. But in the 1990s, psychiatrists began looking more closely for symptoms in younger patients.
Some experts say greater awareness, reflected in the increasing diagnoses, is letting youngsters with the disorder obtain the treatment they need.
Other experts say bipolar disorder is overdiagnosed. The term, the critics say, has become a catchall applied to almost any explosive, aggressive child.
After children are classified, the experts add, they are treated with powerful psychiatric drugs that have few proven benefits in children and potentially serious side effects like rapid weight gain.
In the study, researchers from New York, Maryland and Madrid analyzed a National Center for Health Statistics survey of office visits that focused on doctors in private or group practices. The researchers calculated the number of visits in which doctors recorded diagnoses of bipolar disorder and found that they increased, from 20,000 in 1994 to 800,000 in 2003, about 1 percent of the population under age 20.
The spread of the diagnosis is a boon to drug makers, some psychiatrists point out, because treatments typically include medications that can be three to five times more expensive than those for other disorders like depression or anxiety.
“I think the increase shows that the field is maturing when it comes to recognizing pediatric bipolar disorder, but the tremendous controversy reflects the fact that we haven’t matured enough,” said Dr. John March, chief of child and adolescent psychiatry at the Duke University School of Medicine, who was not involved in the research.
“From a developmental point of view,” Dr. March said, “we simply don’t know how accurately we can diagnose bipolar disorder or whether those diagnosed at age 5 or 6 or 7 will grow up to be adults with the illness. The label may or may not reflect reality.”
Most children who qualify for the diagnosis do not proceed to develop the classic features of adult bipolar disorder like mania, researchers have found. They are far more likely to become depressed.
Dr. Mani Pavuluri, director of the pediatric mood disorders program at the University of Illinois, Chicago, said the label was often better than any of the other diagnoses often given to difficult children.
“These are kids that have rage, anger, bubbling emotions that are just intolerable for them,” Dr. Pavuluri said, “and it is good that this is finally being recognized as part of a single disorder.”
The senior author of the study, Dr. Mark Olfson of the New York State Psychiatric Institute at the Columbia University Medical Center, said, “I have been studying trends in mental health services for some time, and this finding really stands out as one of the most striking increases in this short a time.”
The increase makes bipolar disorder more common among children than clinical depression, the authors said. Psychiatrists made almost 90 percent of the diagnoses, and two-thirds of the young patients were boys, said the study, published in the September issue of The Archives of General Psychiatry.
About half the patients were identified as having other mental difficulties, mostly attention deficit disorder.
The children’s treatments almost always included medication. About half received antipsychotic drugs like Risperdal from Janssen or Seroquel from Astrazeneca, both developed to treat schizophrenia.
A third were prescribed so-called mood stabilizers, most often the epilepsy drug Depakote. Antidepressants and stimulants were also common.
Most children took a combination of two or more drugs, and 4 in 10 received psychotherapy.
The regimens were similar to those of a group of adults with bipolar diagnoses, the study found.
“You get the sense looking at the data that doctors are generalizing from the adult literature and applying the same principles to children,” Dr. Olfson said.
The increased children’s diagnoses reflect several factors, experts say. Symptoms appear earlier in life than previously thought, in teenagers and young children who later develop the full-scale disorder, recent studies suggest.
The label also gives doctors and desperate parents a quick way to try to manage children’s rages and outbursts in an era when long-term psychotherapy and hospital care are less accessible, they say.
In addition, drug makers and company-sponsored psychiatrists have been encouraging doctors to look for the disorder since several drugs were approved to treat it in adults.
Last month, the Food and Drug Administration approved one of the medications, Risperdal, to treat bipolar in children. Experts say they expect that move will increase the use of Risperdal and similar drugs for young people.
“We are just inundated with stuff from drug companies, publications, throwaways, that tell us six ways from Sunday that, Oh my God, we’re missing bipolar,” said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at the Stony Brook University School of Medicine on Long Island. “And if you’re a parent with a difficult child, you go online, and there’s a Web site for bipolar, and you think: ‘Thank God, I’ve found a diagnosis. I’ve found a home.’ ”
Some parents whose children have received the diagnosis say that, with time, the label led to effective treatment.
“It’s been a godsend for us,” said Kelly Simons of Montrose, Colo., whose son Brit, 15, was prone to angry outbursts until given a combination of lithium, a mood stabilizer, and Risperdal, which was often given to children “off label,” several years ago. He now takes just lithium and is an honor roll student.
Other parents say their children have suffered side effects of drugs for bipolar disorder.
Ashley Ocampo, 40, of Tallahassee, Fla., whose 8-year-old son is being treated for bipolar, said that he had tried several antipsychotic drugs and mood stabilizers and that he had improved.
“He has gained weight,” Ms. Ocampo said, “to the point where we were struggling find clothes for him. He’s had tremors and still has some fine motor problems that he’s getting therapy for. But he’s a fabulous kid. And I think, I hope, that we’re close to finding the right combination of medications to help him.”
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