Classifying Mood Symptom Trajectories in Adolescents With Bipolar Disorder.
Classifying Mood Symptom Trajectories in Adolescents With Bipolar Disorder.
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对双相情感障碍青少年的情绪症状轨迹进行分类。
DOI：
10.1016/j.jaac.2019.04.028
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发表时间：
2020
影响因子：
13.3
通讯作者：
Miklowitz,DavidJ
中科院分区：
文献类型：
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作者：
Weintraub,MarcJ;Schneck,ChristopherD;Axelson,DavidA;Birmaher,Boris;Kowatch,RobertA;Miklowitz,DavidJ
目的双相青少年研究的过程和结果发现，双相情感障碍的儿童和青少年在8年的随访中遵循了4种不同情绪轨迹中的1种，多达25%的参与者表现出以愉悦为主的过程。我们评估了在参加为期两年的临床试验的双相I和II障碍的青少年中是否观察到了类似的病程模式。在研究的前9个月，参与者被随机分配到2个心理社会家庭治疗中的一个，并在整个2年中提供药物治疗。使用潜在的班级增长分析，我们根据两年来收集的情绪评级将参与者分为不同的病程。结果潜伏期班级成长分析显示四种情绪轨迹：“主要为欣快型”(占样本的29.9%)、“病程明显改善的病人”(11.1%)、“中度喜怒型”(26.4%)及“病程改善适中的病症”(32.6%)。这些班级的青少年在随访周中的欣快度分别为77.7%、53.6%、44.1%和18.6%。心理社会治疗状况和基线药物暴露与运动轨迹无关。然而，随着时间的推移，基线抑郁症状、自杀倾向、生活质量得分较低、少数族裔/民族的年轻人有更多的症状性病程。结论相当大比例(25%−30%)的双相I或II障碍青年在较长的随访期内保持愉悦状态。确定哪些年轻人随着时间的推移越来越不可能保持稳定，这可能有助于指导疾病发作后的心理社会和药物治疗。临床试验注册信息以家庭为重点的治疗加上药物疗法对青少年双相情感障碍的有效性；https://clinicaltrials.gov/；NCT00332098。
ObjectiveThe Course and Outcome of Bipolar Youth study found that children and adolescents with bipolar spectrum disorders followed 1 of 4 distinct mood trajectories over 8 years of follow-up, with as many as 25% of participants showing a predominantly euthymic course. We evaluated whether similar patterns of illness course are observed in adolescents with bipolar I and II disorder who participated in a 2-year clinical trial.MethodA total of 144 adolescents with bipolar I or II disorder, identified shortly after a mood episode, were assessed over a 2-year period. Participants were randomly assigned to one of 2 psychosocial family treatments during the first 9 months of the study, and pharmacotherapy was provided throughout the 2 years. Using latent class growth analyses, we classified participants into distinct courses of illness based on mood ratings collected over the 2 years. We examined demographic and illness variables as predictors of these course classifications.ResultsLatent class growth analyses indicated four mood trajectories: “predominantly euthymic” (29.9% of sample), “ill with significantly improving course” (11.1%), “moderately euthymic” (26.4%), and “ill with moderately improving course” (32.6%). Adolescents in these classes were euthymic 77.7%, 53.6%, 44.1%, and 18.6% of the weeks of follow-up, respectively. Psychosocial treatment condition and baseline medication exposure were not associated with trajectories. However, youth with more severe baseline depressive symptoms, suicidality, lower quality of life scores, and minority race/ethnicity had more symptomatic courses of illness over time.ConclusionA substantial proportion (25%−30%) of youth with bipolar I or II disorder maintain euthymic states over extended periods of follow-up. Identifying youth who are more and less likely to remain stable over time may help guide psychosocial and pharmacological treatments after an illness episode.Clinical trial registration informationEffectiveness of Family-Focused Treatment Plus Pharmacotherapy for Bipolar Disorder in Adolescents; https://clinicaltrials.gov/; NCT00332098.