Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype
Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype
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DOI：
10.1001/archpsyc.61.5.459
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发表时间：
2004-05-01
影响因子：
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通讯作者：
Bolhofner, K
中科院分区：
文献类型：
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作者：
Geller, B;Tillman, R;Bolhofner, K
背景资料：诊断儿童manias.Objective：探讨自然史和前瞻性验证的存在和长期发作持续时间的maniasinchild.Design：四年的前瞻性纵向研究86例受试者与摄入发作躁狂症谁都在6，12，18，24，36和48个月进行评估。表型被定义为DSM-IV双相I型障碍（躁狂或混合型），至少有一个主要症状（焦虑和/或夸大），以确保与注意力缺陷/多动障碍的区分。父母和孩子的线人分别采访，由经验丰富的研究护士，使用华盛顿大学圣刘易斯儿童情感障碍和精神分裂症（WASH-U-KSADS）的时间表。儿童总体评估量表得分为60分或更低，以确定明确的损害。治疗是由受试者的社区practitioners.Setting：研究单位在一所大学医学院参与者：受试者获得从精神科和儿科网站连续新的情况下ascertainment，和他们的基线年龄为10.8 +/- 2.7岁。基线发作时间为7.4 ± 3.5年。(Data以平均值+/-SD给出）。主要结局指标：发作持续时间，周生病，恢复/复发率，和outcomepredictors.Results：前瞻性发作持续时间躁狂症的诊断，使用躁狂发作作为基线日期，是79.2 +/- 66.7连续周。在209.4 +/- 3.3周的随访期间，任何双相情感障碍诊断发生在总周数的67.1% +/- 28.5%期间。受试者在躁狂或轻躁狂（单相或混合型）的总周数中占56.9% +/- 28.8%，其中38.7% +/- 28.8%为躁狂。重度或轻度抑郁和恶劣心境（单极或混合型）发生在总周数的47.1% ± 30.4%。极性转换每年发生1.1 +/- 0.7次。母亲体温低预示躁狂症恢复后复发快（X-2=13.6，P= 0.0002），精神病预示躁狂或轻躁狂患者患病时间更长（F-1.80= 12.2，P= 0.0008）。青春期状态和性别不能预测。(Data以平均值+/-SD给出）。结论：这些发现证实了儿童躁狂症的存在、长发作持续时间和慢性化。成人双相情感障碍的自然史的差异进行了讨论。
Background: Diagnosis of child mania has been contentious.Objective: To investigate natural history and prospective validation of the existence and long-episode duration of mania in children.Design: Four-year prospective longitudinal study of 86 subjects with intake episode mania who were all assessed at 6, 12, 18, 24, 36, and 48 months. The phenotype was defined as DSM-IV bipolar I disorder (manic or mixed) with at least I cardinal symptom (elation and/or grandiosity) to ensure differentiation from attention-deficit/hyperactivity disorder. Parent and child informants were separately interviewed, by highly experienced research nurses, using the Washington University in St Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS). A Children's Global Assessment Scale score of 60 or less was needed to establish definite impairment. Treatment was by subjects' community practitioners.Setting: Research unit in a university medical schoolParticipants: Subjects were obtained from psychiatric and pediatric sites by consecutive new case ascertainment, and their baseline age was 10.8 +/- 2.7 years. Onset of the baseline episode was 7.4 +/- 3.5 years. (Data are given as mean +/-SD.)Main Outcome Measures: Episode duration, weeks ill, recovery/relapse rates, and outcome predictors.Results: Prospective episode duration of manic diagnoses, using onset of mania as baseline date, was 79.2 +/- 66.7 consecutive weeks. Any bipolar disorder diagnosis occurred during 67.1% +/- 28.5% of total weeks, during the 209.4 +/- 3.3 weeks of follow-up. Subjects spent 56.9% +/- 28.8% of total weeks with mania or hypomania (unipolar or mixed), and 38.7% +/- 28.8% of these were with mania. Major or minor depression and dysthymia (unipolar or mixed) occurred during 47.1% +/- 30.4% of total weeks. Polarity switches occurred 1.1 +/- 0.7 times per year. Low maternal warmth predicted faster relapse after recovery from mania (X-2=13.6, P=.0002), and psychosis predicted more weeks ill with mania or hypomania (F-1.80= 12.2, P=.0008). Pubertal status and sex were not predictive. (Data are given as mean +/-SD.)Conclusions: These findings validate the existence, long-episode duration, and chronicity of child mania. Differences from the natural history of adult bipolar disorder are discussed.