Supplementary Material for: Mood and Anxiety Disorders as Early Manifestations of Medical Illness: A Systematic Review

Background: Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. Methods: MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were ‘prodrome/early symptom', combined using the Boolean ‘AND' operator with ‘anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean ‘AND' operator with ‘medical illness/medical disorder'. PRISMA guidelines were followed. Results: A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Conclusions: Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

背景：涉及心境、焦虑及易激惹改变的情感障碍，可能是内科疾病的早期症状。本研究旨在对相关文献开展系统综述，并进行定性数据综合分析。
方法：本研究于2014年2月前，系统检索了MEDLINE、PsycINFO、EMBASE、Cochrane及ISI Web of Science数据库自建库以来的全部文献。检索策略采用布尔逻辑"AND"运算符组合：以"前驱症状（prodrome/early symptom）"为核心检索词，联合"焦虑（anxiety）/抑郁（depression）/躁狂（mania）/轻躁狂（hypomania）/易激惹（irritability）/易怒心境（irritable mood）/敌对情绪（hostility）"，再联合"内科疾病（medical illness/medical disorder）"。本研究严格遵循PRISMA报告规范。
结果：最终共有21项符合纳入标准的研究被纳入分析。研究发现，抑郁是内科疾病最常见的情感前驱症状，该结论在库欣综合征（Cushing's syndrome）、甲状腺功能减退症、甲状旁腺功能亢进症、胰腺癌与肺癌、心肌梗死、威尔逊病（Wilson's disease）及艾滋病（AIDS）中均有一致报道。躁狂、焦虑及易激惹的检出频率相对较低。
结论：临床医师可能会对看似精神科范畴的病例，忽略其内科排查工作。临床医师应警惕：心境、焦虑及易激惹异常，可能早于内科疾病的显性发病出现。