Longitudinal Trajectories and Associated Baseline Predictors in Youths With Bipolar Spectrum Disorders
Longitudinal Trajectories and Associated Baseline Predictors in Youths With Bipolar Spectrum Disorders
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DOI：
10.1176/appi.ajp.2014.13121577
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发表时间：
2014-09-01
影响因子：
17.7
通讯作者：
Keller, Martin B.
中科院分区：
文献类型：
--
作者：
Birmaher, Boris;Gill, Mary Kay;Keller, Martin B.
目的：作者试图确定和评估纵向情绪轨迹和相关的基线预测因素在青少年双相disorder.Method：共367门诊青年（平均年龄，12.6岁）与双相情感障碍，至少有4年的后续包括在内。在接受调查后，参与者在平均93个月（SD=8.3）内平均接受了10.5次（SD=3.2）的采访。青少年和家长接受了采访的精神病理学，功能，功能，治疗，和家庭精神病理学和functioning.Results：潜在类增长分析显示了四个不同的纵向情绪轨迹：“主要是euthymic”（24.0%），“适度euthymic”（34.6%），“病与改善过程”（19.1%），和“主要是病”（22.3%）。在每个班级中，平均分别有84.4%、47.3%、42.8%和11.5%的青少年在随访时间内情绪正常。多变量分析显示，较好的病程与情绪症状发作时的年龄较高、双相情感障碍和物质滥用的终生家族史较少、严重抑郁、躁狂症状、自杀、亚综合征情绪发作和性虐待的基线史较少相关。这些因素中的大多数在“主要是胸腺正常”类中更显着。发病年龄的影响减弱，在青年与较低的社会经济地位，和抑郁症的严重程度的影响是缺席的那些最高的社会经济地位.Conclusions：一个相当大的比例的青少年与双相情感障碍，特别是那些青少年发病和上述因素，似乎是在较长的时间内，情绪正常。尽管如此，在所有四个类别中持续的综合征和亚综合征情绪症状强调了优化治疗的必要性。
Objective: The authors sought to identify and evaluate longitudinal mood trajectories and associated baseline predictors in youths with bipolar disorder.Method: A total of 367 outpatient youths (mean age, 12.6 years) with bipolar disorder with at least 4 years of follow-up were included. After intake, participants were interviewed on average 10.times (SD=3.2) over a mean of 93 months (SD=8.3). Youths and parents were interviewed for psychopathology, functioning, functioning, treatment, and familial psychopathology and functioning.Results: Latent class growth analysis showed four different longitudinal mood trajectories: "predominantly euthymic" (24.0%), "moderately euthymic" (34.6%), "ill with improving course" (19.1%), and "predominantly ill" (22.3%). Within each class, youths were euthymic on average 84.4%, 47.3%, 42.8%, and 11.5% of the follow-up time, respectively. Multivariate analyses showed that better course was associated with higher age at onset of mood symptoms, less lifetime family history of bipolar disorder and substance abuse, and less history at baseline of severe depression, manic symptoms, suicidality, subsyndromal mood episodes, and sexual abuse. Most of these factors were more noticeable in the "predominantly euthymic" class. The effects of age at onset were attenuated in youths with lower socioeconomic status, and the effects of depression severity were absent in those with the highest socioeconomic status.Conclusions: A substantial proportion of youths with bipolar disorder, especially those with adolescent onset and the above-noted factors, appear to be euthymic over extended periods. Nonetheless, continued syndromal and subsyndromal mood symptoms in all four classes underscore the need to optimize treatment.