抑郁癥患者究竟有多危險?

Ask Well: Jet Crash Raises Questions on Mental Illness Risks

抑郁癥患者究竟有多危險?

The crash of the Germanwings jetliner has raised questions about mental illness and its consequences. Authorities have said that Andreas Lubitz, the co-pilot believed to have intentionally crashed the plane into the Alps, had a mental illness that he hid from the airline, that he was treated for “suicidal tendencies” before he got his pilot’s license, and that antidepressants were found in his apartment.

德國之翼(Germanwings)客機墜毀事件引發(fā)了公眾對精神疾病及其影響的討論。當局稱，據(jù)信故意讓客機墜毀在阿爾卑斯山的副駕駛安德烈亞斯·盧比茨(Andreas Lubitz)，向德國之翼隱瞞了他患有精神疾病的事實;早在拿到飛行員執(zhí)照前，他就因有“自殺傾向”而接受過治療;調(diào)查人員在他的公寓里發(fā)現(xiàn)了抗抑郁藥。

Dr. Richard Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, will be responding to reader questions about mental illness and its risks.

韋爾·康奈爾醫(yī)學院(Weill Cornell Medical College)臨床精神病學教授理查德·弗里德曼(Richard Friedman)，將回應(yīng)讀者提出的與精神疾病及其風險有關(guān)的問題。

Q. Are most people who kill themselves depressed? What’s the relationship between suicide and depression?

問：大部分自殺者都患有抑郁癥嗎?自殺和抑郁癥是什么關(guān)系?

A. We know from psychological autopsies that more than 90 percent of people who commit suicide have a diagnosable and potentially treatable psychiatric illness, most often depression — very often associated with alcohol or other drug abuse. Psychotic disorders like schizophrenia and schizoaffective disorder are also associated with an increased risk of suicide.

答：心理驗尸研究表明，超過90%的自殺者被診斷為患有存在治愈可能的心理疾病，大多是抑郁癥——常常涉及酗酒或者藥物濫用。精神分裂癥以及分裂情感性障礙等精神障礙，也會加大自殺的風險。

Q. Are antidepressant medications prescribed only for depression or also for other illnesses or conditions?

問：抗抑郁藥物只能治療抑郁癥嗎，還是說也可以治療其他疾病?

A. Antidepressants are effective in the treatment of a wide range of psychiatric disorders, including depression and anxiety disorders like obsessive compulsive disorder, panic disorder and generalized anxiety disorder. They are also used in patients with certain personality disorders, such as borderline personality disorder, who may experience depressive symptoms

答：抗抑郁藥物能有效治療包括抑郁癥和焦慮癥在內(nèi)的多種精神障礙，其中焦慮癥又包括強迫癥、恐慌癥、泛焦慮癥等?？挂钟羲幬镞€被用于治療患有某種人格障礙的患者，比如可能會出現(xiàn)抑郁癥狀的邊緣性人格障礙患者。

Q. Are people who commit mass murder and suicide typically depressed? Is there a pattern of mental disorders associated with such rare acts?

問：謀殺多人者和自殺者通常都患有抑郁癥嗎?他們的罕見行為和精神障礙之間是否存在某種規(guī)律?

A. Mass murderers are typically young men who are loners, harbor a grudge and are very often psychotic. Those who commit murder-suicide are likely a different group of individuals. Murder-suicide is very rare, about 0.2 to 0.3/100,000 per year. Most of the perpetrators are men (40 to 50 years old), and the most common mental problem by psychological autopsy is depression. Those who commit murder-suicide typically kill people with whom they have been close (spouse, parent or child) and the motive is very often revenge.

答：謀殺多人者通常是獨來獨往、心懷怨恨的年輕男性，而且常?；加芯窦膊　⑷撕笞詺⒄咚坪鯌?yīng)該被歸入另外一個群體。殺人后自殺的行為非常罕見，每年的發(fā)生率在十萬分之零點二到十萬分之零點三之間。大部分施害者是男性(40至50歲)，通過心理驗尸可以確定，抑郁癥是他們最常患有的精神疾病。殺人后自殺者殺的通常是跟他們很親近的人(配偶，父母或者孩子)，其動機通常是復(fù)仇。

Q. How common are suicidal thoughts and is it possible to predict who will actually commit suicide?

問：自殺的念頭有多常見?有沒有可能預(yù)測誰真的會自殺?

A. Suicidal thinking is probably fairly common in the general population and certainly much higher in people with psychiatric disorders like depression. While we know that there are clear risk factors for suicide — like having a mood disorder, being older or being male — most people with these characteristics do not go on to commit suicide, so our current ability to accurately predict suicide is low.

答：自殺的念頭在一般人群中可能相當常見，在患有抑郁癥等精神障礙的人群中則愈發(fā)常見。我們知道，患有情感障礙、年齡偏長或者性別為男等因素與自殺風險之間存在明顯的關(guān)聯(lián)，但大部分具有這些特征的人并不會自殺。因此，實際上很難預(yù)測誰會自殺。

Q. Are you concerned that this case and coverage of it is further stigmatizing people who suffer from depression?

問：你是否擔心這件事及相關(guān)新聞報道會讓抑郁癥患者進一步被妖魔化。

A. I always worry about that. Horrifying outliers, like this case, create the false impression that psychiatric patients are dangerous, when we know the overwhelming amount of violence is perpetrated by normal people in the grip of normal human emotions. Still, there is no question that people with certain serious psychiatric illnesses are at a slightly higher risk of harming themselves and others compared with those without psychiatric illnesses, but the absolute risk is small.

答：我一直有這樣的擔憂。要知道，絕大多數(shù)暴力行為的實施者都是受控于正常人類情感的普通人，但可怕的極端案例——比如這件事——會讓人錯誤地認為精神疾病患者很危險。毫無疑問，與沒有精神疾病的人相比，患有某些嚴重精神疾病的人傷害自己或者他人的風險偏高一些，但絕對風險是很低的。

Q. Does depression ever really go away?

問：抑郁癥真的能被治愈嗎?

A. Depression is often a chronic illness characterized by relapses and recurrences, but it is also very treatable. Antidepressant medication and psychotherapy are effective not just in treating acute episodes of depression, but in preventing relapses as well.

答：抑郁癥往往是慢性病，具有復(fù)發(fā)和再發(fā)的特點，但同時它絕對是可治療的?？挂钟羲幬锖托睦懑煼ú粌H可以有效應(yīng)對抑郁癥的急性發(fā)作，而且可以防止抑郁癥的復(fù)發(fā)。

Q. Do patients with bipolar disorder frequently attempt suicide?

問：雙相障礙患者常常企圖自殺?

A. Yes. Suicide risk in bipolar disorder is estimated to be about 0.4 percent per year, compared with a risk in the general population of about 0.014 percent per year. So the risk of suicide in people with bipolar disorder is roughly 25 times that of the general population.

答：是的。據(jù)估計，雙相障礙患者每年自殺的概率為0.4%;相比之下，一般人的概率約為0.014%。因此，雙相障礙患者的自殺風險約為一般人的25倍。