Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review
Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review
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DOI：
10.1016/j.jad.2003.12.011
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发表时间：
2004-10-01
影响因子：
6.6
通讯作者：
Austin, NB
中科院分区：
文献类型：
--
作者：
Faedda, GL;Baldessarini, RJ;Austin, NB
背景资料：儿童双相情感障碍（BPD）可能被误诊为抑郁症、注意力障碍、品行障碍或焦虑症，常用抗抑郁药和兴奋剂治疗。与此类治疗相关的不良结局风险仍然定义不清。研究方法：我们分析了82例符合改良DSM-IV诊断标准的BPD儿童（平均年龄10.6岁）的临床记录，以评估药物治疗后操作定义的治疗后出现的躁狂（TEM）或情绪周期增加的风险和时间。结果如下：在82名青少年BPD患者中，57名（69%）至少接受过一次情绪提升剂; 33/57名（58%）暴露者符合TEM标准，中位潜伏期为14天;抗抑郁药的TEM观察频率是兴奋剂的两倍（44% vs. 18%）。TEM导致14例（17%）首次识别BPD，一些药物暴露儿童（4-9%）有明显的自杀，杀人或精神病行为。除了最近暴露于情绪提升剂，TEM与早发性焦虑和女性有关。局限性：研究结果是回顾性的，在临床诊断和治疗的门诊病人，但涉及其他青少年BPD病例。结论：58%的可能患有青少年BPD的儿童在新暴露于情绪升高剂的几周内报告了TEM。(C)2004 Elsevier B. V.保留所有权利。
Background: Pediatric bipolar disorder (BPD) can be misdiagnosed as a depressive, attention, conduct, or anxiety disorder and treatment with antidepressants and stimulants is common. Risk of adverse outcomes related to such treatment remains poorly defined. Methods: We analyzed clinical records of 82 children (mean age 10.6 years) meeting modified DSM-IV diagnostic criteria for BPD to evaluate risk and timing of operationally-defined treatment-emergent mania (TEM) or increased mood-cycling following pharmacological treatment. Results: Of 82 juvenile BPD patients, 57 (69%) had been given a mood-elevating agent at least once; 33/57 (58%) so-exposed met criteria for TEM, with median latency of 14 days; TEM was observed twice as often with antidepressants as stimulants (44% vs. 18%). TEM led to first-recognition of BPD in 14 cases (17%), and some drug-exposed children (4-9%) had prominent suicidal, homicidal or psychotic behavior. In addition to recent exposure to a mood-elevating agent, TEM was associated with early-onset anxiety and female gender. Limitations: Findings are retrospective in clinically diagnosed and treated outpatients, but involved otherwise unselected cases of juvenile BPD. Conclusions: TEM was reported in 58% of children with probable juvenile BPD within several weeks of new exposure to a mood-elevating agent. (C) 2004 Elsevier B.V. All rights reserved.