据估计,短时精神障碍 (BPD) 发生在普通人群中发病率为 0.1%~0.5%。[2]Castagnini A, Bertelsen A, Berrios GE. Incidence and diagnostic stability of ICD-10 acute and transient psychotic disorders. Comp Psychiatry. 2008;49:255-261.http://www.ncbi.nlm.nih.gov/pubmed/18396184?tool=bestpractice.com[3]Perala J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007;64:19-28.http://archpsyc.ama-assn.org/cgi/content/full/64/1/19http://www.ncbi.nlm.nih.gov/pubmed/17199051?tool=bestpractice.com大部分研究报告显示 BPD 更常见于女性;但该结论仍具争议性。[2]Castagnini A, Bertelsen A, Berrios GE. Incidence and diagnostic stability of ICD-10 acute and transient psychotic disorders. Comp Psychiatry. 2008;49:255-261.http://www.ncbi.nlm.nih.gov/pubmed/18396184?tool=bestpractice.com[3]Perala J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007;64:19-28.http://archpsyc.ama-assn.org/cgi/content/full/64/1/19http://www.ncbi.nlm.nih.gov/pubmed/17199051?tool=bestpractice.com[4]Jorgensen P, Bennedsen B, Christensen J. Acute and transient psychotic disorder: comorbidity with personality disorder. Acta Psychiatr Scand. 1996;94:460-464.http://www.ncbi.nlm.nih.gov/pubmed/9021000?tool=bestpractice.com BPD 在发展中国家/地区以及具人格障碍的人群中[5]Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting. Arch Gen Psychiatry. 1994;51;294-301.http://www.ncbi.nlm.nih.gov/pubmed/8161289?tool=bestpractice.com更常见。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.[4]Jorgensen P, Bennedsen B, Christensen J. Acute and transient psychotic disorder: comorbidity with personality disorder. Acta Psychiatr Scand. 1996;94:460-464.http://www.ncbi.nlm.nih.gov/pubmed/9021000?tool=bestpractice.com[6]Ungvari GS, Mullen PE. Reactive psychoses revisited. Aust NZ J Psychiatry. 2000;34;458-467.http://www.ncbi.nlm.nih.gov/pubmed/10881970?tool=bestpractice.com
有 3 种类型的 BPD:
伴有明显应激因素:如果精神病症状是对 1 个或多个事件的反应,并且此类似情形对任何当事人都是明显的应激性事件,则可诊断为该类型(以前称为“短时反应性精神病”)。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.在美国空军招募时,该类型 BPD 的发病率为 1.4/100,000;但这些数据不是战时收集的。[7]Beighley PS, Brown GR, Thompson JW Jr. DSM-III-R brief reactive psychosis among Air Force recruits. J Clin Psychiatry. 1992;53:283-288.http://www.ncbi.nlm.nih.gov/pubmed/1500405?tool=bestpractice.com在美国该类型 BPD 的发病率可能于 2001 年 9 月 11 日恐怖袭击后立即有所增加,但此推断并无确切证据支持。然而,在美国东北部(远离纽约)有 2 例 BPD 病例报告,这两个人因为媒体对恐怖袭击的报道受到刺激。[8]Rushing SE, Jean-Baptiste M. Two cases of brief psychotic disorder related to media coverage of the September 11, 2001 events. J Psychiatric Prac. 2003;9:87-90.http://www.ncbi.nlm.nih.gov/pubmed/15985919?tool=bestpractice.com
不伴明显应激因素:当精神病症状不是表现为对应激性事件的反应时,则诊断为该类型。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.患病率和发病率尚不清楚。
产后发作:当产后 4 周内出现精神病症状时,则诊断为这种类型。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.估计每 1000 例女性中有 1 至 2 例会发生产后精神病。[9]Engqvist, I, Nilsson A, Nilsson K, et al. Strategies in caring for women with postpartum psychosis: an interview study with psychiatric nurses. J Clin Nurs. 2007;16:1333-1342.http://www.ncbi.nlm.nih.gov/pubmed/1717584352?tool=bestpractice.com分娩前因精神病而住院与产后 BPD 的发生率较高相关 (9.3%),[10]Harlow BL, Vitonis AF, Sparen P, et al. Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior pregnancy or prenatal psychiatric hospitalizations. Arch Gen Psychiatry. 2007;64:42-48.http://www.ncbi.nlm.nih.gov/pubmed/17199053?tool=bestpractice.com在产前受到压力同样如此。[11]Malhotra S, Malhotra S. Acute and transient psychotic disorders: comparison with schizophrenia. Curr Psychiatry Rep. 2003;5:178-186.http://www.ncbi.nlm.nih.gov/pubmed/12773269?tool=bestpractice.com