Gender, suicidality and bipolar mixed states in adolescents
Gender, suicidality and bipolar mixed states in adolescents
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DOI：
10.1016/j.jad.2005.02.003
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发表时间：
2005-07-01
影响因子：
6.6
通讯作者：
Akiskal, HS
中科院分区：
文献类型：
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作者：
Dilsaver, SC;Benazzi, F;Akiskal, HS
背景：本研究的目的是确定以DSM-IV定义的重性抑郁发作（MDE）就诊的青少年门诊患者的混合状态与自杀倾向之间的关系。对247名符合MDE标准的青少年进行了筛查，以确定是否存在并发的MDE内轻躁狂/躁狂（即，混合状态）。所有患者都被询问他们是否有当前的自杀想法或最近尝试过任何与死亡想法相关的自我毁灭性身体行为（即，自杀企图）。结果：247名青少年中有100名（40.5%）为双相I型或II型。其中，82%处于混合状态。在有自杀意念的患者中，62.8%是女孩，在有自杀企图史的患者中，69.4%是女孩。女孩有自杀意念的风险是男孩的两倍多（OR=2.2，p=0.004），有自杀企图史的风险是男孩的近3倍（OR=2.87，p < 0.0001）。在所有247名患者中，处于混合状态本身并不能预测自杀意念或自杀企图。然而，混合状态显然只在女孩中独立地导致（非致命性）自杀行为的风险。在混合状态中，女孩自杀未遂的风险是非混合状态的近4倍（OR= 3.9，p-0.003）。年龄、精神病特征和心境障碍家族史与自杀倾向关系不大或没有关系。局限性：相关性图表回顾研究，没有数据收集轴I和轴它comorbidity和不良生活事件。结论：这份报告更大的自杀倾向的青春期女孩在混合状态平行的知名成人文学的高频率的混合状态的妇女。这些发现与青少年抑郁症患者中抗抑郁药和自杀倾向的争议有关，因为它们确定了一个弱势群体。与资深作者[Akiskal，H.S.，1995.双相情感的发展途径：青少年抑郁症是双相情感的前期吗？J. Am. Acad.儿童青少年Psych.34，754-763]，我们的数据突出了更广泛地认识到青少年患者伪装成单极抑郁症的双相混合状态的公共卫生重要性。最后，在我们看来，这是我们对混合状态的正式疾病分类学的失败，而不是抗抑郁药本身，这是这场争论的根本问题。(c)2005年由Elsevier B. V.出版
Background:The purpose of this study was to determine the relationship between mixed states and suicidality among adolescent outpatients presenting with a DSM-IV defined major depressive episode (MDE).Methods. Two-hundred and forty-seven adolescents meeting the criteria for MDE were screened for the presence of concurrent, intra-MDE hypomania/mania (i.e., mixed states). All patients were asked whether they had current suicidal ideation or had recently attempted any self-destructive physical act associated with the thought of dying (i.e., a suicide attempt). The data were subjected to analysis using univariate logistic regression.Results: One hundred of the 247 (40.5%) adolescents were bipolar type I or type II. Of these, 82% were in mixed states. Of the patients with suicidal ideation, 62.8% were girls, and of those with histories of a suicide attempt, 69.4% were girls. Girls had more than twice the risk of having suicidal ideation (OR=2.2, p=0.004) and nearly 3 times the risk of having histories of a suicide attempt than boys (OR=2.87, p < 0.0001). Being in a mixed state per se did not predict either suicidal ideation or a suicide attempt among all of the 247 patients. However, mixed states apparently independently contributed to the risk of (non-fatal) Suicidal behavior among girls only. Of the mixed states, girls had nearly 4 times the risk of having made a suicide attempt compared with those without mixed states (OR=3.9,p-0.003). Age, presence of psychotic features and family history of mood disorder had little or no bearing on suicidality. Limitations: Correlational chart review study, no data collection on Axis I and Axis It comorbidity and adverse life-events.Conclusions: This report of greater suicidality in adolescent girls in a mixed state parallels the well-known adult literature of high frequency of mixed states in women. The findings are of relevance to the controversy of antidepressants and suicidality in juvenile depressives in that they identify a vulnerable group. In tine with earlier suggestions by the senior author [Akiskal, H.S., 1995. Developmental pathways to bipolarity: are juvenile-onset depressions pre-bipolar? J. Am. Acad. Child Adolesc. Psych. 34, 754-763], our data highlight the public health importance of the wider recognition of bipolar mixed states in juvenile patients masquerading as unipolar depression. Finally, it appears to us that it is the failure of our formal nosology on mixed states-rather than the antidepressants per se-which is the root problem in this controversy. (c) 2005 Published by Elsevier B.V.