Precursors of Bipolar Disorders: A Systematic Literature Review of Prospective Studies
Precursors of Bipolar Disorders: A Systematic Literature Review of Prospective Studies
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DOI：
10.4088/jcp.13r08900
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发表时间：
2015-05-01
影响因子：
5.3
通讯作者：
Koukopoulos, Athanasios
中科院分区：
文献类型：
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作者：
Faedda, Gianni L.;Marangoni, Ciro;Koukopoulos, Athanasios
目的：在前瞻性研究中评估情感体征和症状作为双相情感障碍前兆的存在，包括评估其患病率、持续时间和预测价值。数据来源：我们遵循PRISMA指南检索PubMed、CINAHL、PsycINFO、EMBASE、SCOPUS和ISI Web of Science数据库，截止日期为2013年5月31日，使用术语双相情感障碍和（先行者 * 或预测 * 或前驱 * 或前景 *）和（诊断或发展）。研究选择：我们仅纳入包含以下内容的英文文章：（1）前瞻性、纵向研究，至少有2项结构化临床评估（纳入和随访）;（2）既往无DSM-III或DSM-IV诊断的双相I型或双相II型;（3）双相I型或双相II型的诊断结果。排除了双相情感障碍的家族风险受试者的研究，因为这些研究已经在别处进行了综述。数据提取：我们将研究设计、结果、前兆和预测值的细节制成表格。只有研究报告的阳性预测associationwere included.Results：在26发表的报告符合选择标准，方法差异很大，在设计，随访时间，年龄和调查的人群。尽管在方法上存在这样的异质性，但结果非常一致。双相情感障碍的前兆包括情绪不稳定、亚综合征和重性抑郁症、伴有或不伴有重性抑郁症的亚综合征轻躁狂症状、循环性心境障碍和双相情感障碍（未另作说明）、伴有精神病特征的重性抑郁症和其他精神病性障碍。双相情感障碍也预测青少年发病的抑郁症以及频率和负荷轻躁狂或抑郁symptoms.Conclusions：尽管发表的报告的局限性，前瞻性确定的双相情感障碍的前兆通常出现前几年的综合征发作，往往有显着的早期发病率和残疾。经证实的双相情感障碍的先兆与回顾性和家族风险研究的结果基本一致。结合前兆和其他危险因素可能会增加预测值，支持早期诊断，改善治疗，并限制双相障碍的残疾。(C)版权所有2015 Physicians Postgraduate Press，Inc.
Objective: To evaluate the presence of affective signs and symptoms as precursors of bipolar disorder in prospective studies, including assessment of their prevalence, duration, and predictive value.Data Sources: We followed PRISMA guidelines to search PubMed, CINAHL, PsycINFO, EMBASE, SCOPUS, and ISI Web of Science databases to May 31, 2013, using the terms bipolar disorder AND (antecedent* OR predict* OR prodrom* OR prospect*) AND (diagnosis OR development). Hand searching of identified reports led to additional relevant references.Study Selection: We included only English-language articles containing (1) prospective, longitudinal studies with at least 2 structured clinical assessments (intake and follow-up); (2) no previous DSM-III or DSM-IV diagnoses of bipolar I or bipolar II; and (3) diagnostic outcome of bipolar I or bipolar II. Studies of subjects at familial risk of bipolar disorder were excluded, as these have been reviewed elsewhere.Data Extraction: We tabulated details of study design, outcomes, precursors, and predictive value. Only studies reporting a positive predictive association were included.Results: In 26 published reports meeting selection criteria, methods varied widely in terms of design, duration of follow-up, ages, and populations investigated. Despite such heterogeneity in methods, findings were notably consistent. Precursors of bipolar disorder include mood lability, subsyndromal and major depression, subsyndromal hypomanic symptoms with or without major depression, cyclothymia and bipolar not otherwise specified, major depression with psychotic features, and other psychotic disorders. Bipolar disorder was also predicted by juvenile onset of major depression as well as frequency and loading of hypomanic or depressive symptoms.Conclusions: Despite the limitations of published reports, prospectively identified precursors of bipolar disorder typically arose years prior to syndromal onset, often with significant early morbidity and disability. Prospectively identified precursors of bipolar disorder are generally consistent with findings in retrospective and family-risk studies. Combining precursors and other risk factors may increase predictive value, support earlier diagnosis, improve treatment, and limit disability in bipolar disorder. (C) Copyright 2015 Physicians Postgraduate Press, Inc.