Neurologic examination abnormalities in children with bipolar disorder or Attention-deficit/hyperactivity disorder
Neurologic examination abnormalities in children with bipolar disorder or Attention-deficit/hyperactivity disorder
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DOI：
10.1016/j.biopsych.2004.12.010
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发表时间：
2005-10-01
影响因子：
10.6
通讯作者：
Leibenluft, E
中科院分区：
文献类型：
--
作者：
Dickstein, DP;Garvey, M;Leibenluft, E
背景：注意缺陷多动障碍（ADHD）和双相情感障碍（BPD）经常是共病和重叠的诊断。为了超越诊断独特的病理生理学，我们评估了ADHD和BPD儿童的神经系统检查异常（NEAs）与正常对照组（NC）children.Methods：我们进行了修订后的身体和神经系统检查软迹象三组（ADHD，BPD，NC）。然后，一个对诊断不知情的评估者评估了他们的运动表现。结果采用多元协方差分析。ADHD患者的重复任务反应时受损。相比之下，儿童BPD受试者，无论是否患有共病ADHD。结论：诊断的NEAs的这种差异模式表明ADHD和BPD儿童之间的病理生理差异，重复运动表现需要抑制不相关的运动; ADHD受试者在这一领域的损害支持ADHD涉及额-纹状体-基底神经节神经回路的核心缺陷的假设。相反，BPD受试者受损的顺序运动表现与行为数据一致，表明BPD受试者的注意定势转移和逆转学习受损。进一步的研究超越症状描述，以确定病理生理差异，需要完善这些往往共病诊断的神经元模型。
Background: Atteiition-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) are frequently comorbid and overlapping diagnoses. To move beyond diagnosis toward unique pathophysiology, we evaluated both ADHD and BPD children for neurologic examination abnormalities (NEAs) in comparison with normal control (NC) children.Methods: We performed the Revised Physical and Neurological Examination for Soft Signs in three groups (ADHD, BPD, NC). Then, a rater blind to diagnosis evaluated their motor performance. Results were analyzed with a multiple analysis of covariance.Results. Subjects with ADHD were impaired on repetitive task reaction time. In contrast, pediatric BPD subjects, both with and without comorbid ADHD. were impaired on sequential task reaction time.Conclusions: This differential pattern of NEAs by diagnosis suggests pathophysiologic differences between ADHD and BPD in children, Repetitive motor performance requires inhibition of nonrelevant movements; ADHD subjects' impairment in this domain supports the hypothesis that ADHD involves a core deficit of fronto-striato- basal ganglia neurocircuitry. In contrast, BPD subjects' impaired sequential motor performance is consistent with behavioral data showing impaired attentional set-shifting and reversal learning in BPD subjects. Further study going beyond symptom description to determine pathophysiologic differences, is required to refine neuronal models of these often comorbid diagnoses.