Preventative Strategies for Early-Onset Bipolar Disorder Towards a Clinical Staging Model
Preventative Strategies for Early-Onset Bipolar Disorder Towards a Clinical Staging Model
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DOI：
10.2165/11539700-000000000-00000
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发表时间：
2010-01-01
期刊：
影响因子：
6
通讯作者：
DelBello, Melissa P.
中科院分区：
文献类型：
--
作者：
McNamara, Robert K.;Nandagopal, Jayasree J.;DelBello, Melissa P.
双相情感障碍是一种慢性和典型的复发性疾病，具有显著的社会心理发病率。尽管导致躁狂和双相I型障碍发病的病因学因素尚不清楚，但它最常发生在青少年时期。假定的双相情感障碍的风险因素包括有一级亲属患有情绪障碍、身体/性虐待和其他社会心理压力源、物质使用障碍、精神兴奋剂和抗抑郁药物暴露以及omega-3脂肪酸缺乏。突出的前驱临床特征包括抑郁、焦虑、轻躁狂、愤怒/易怒以及睡眠和注意力障碍的发作性症状。由于前驱情绪症状比躁狂发作平均早10年，而且躁狂的危险因素和前驱症状特征的特异性较低，因此在疾病发作之前（一级预防）或在疾病病程早期（早期或二级预防）开始的干预必须是安全的，并且在长期暴露后具有良好的耐受性。事实上，抗抑郁药和精神兴奋剂药物可能会促使躁狂发作。虽然情绪稳定剂和非典型抗精神病药物在青少年双相I型障碍中表现出疗效，但它们对前驱情绪症状的治疗效果在很大程度上是未知的。此外，情绪稳定剂和非典型抗精神病药物与禁止性治疗相关-出现不良反应。相反，omega-3脂肪酸具有神经营养和神经保护特性，在治疗儿童和青少年躁狂和抑郁症状方面被发现是有效、安全且耐受性良好的。总之，现有的证据支持一种临床分期模式，即在前驱期使用更安全的干预措施（如ω -3脂肪酸，以家庭为中心的治疗）治疗躁狂风险较高的受试者，然后对无反应病例和二级预防使用有潜在不良反应的药物。这种方法值得在确定为双相I型障碍超高风险青年的前瞻性纵向试验中进行评估。
Bipolar disorder is a chronic and typically recurring illness with significant psychosocial morbidity. Although the aetiological factors that contribute to the onset of mania, and by definition bipolar I disorder, are poorly understood, it most commonly occurs during the adolescent period. Putative risk factors for developing bipolar disorder include having a first-degree relative with a mood disorder, physical/sexual abuse and other psychosocial stressors, substance use disorders, psychostimulant and antidepressant medication exposure and omega-3 fatty acid deficiency. Prominent prodromal clinical features include episodic symptoms of depression, anxiety, hypomania, anger/irritability and disturbances in sleep and attention. Because prodromal mood symptoms precede the onset of mania by an average of 10 years, and there is low specificity of risk factors and prodromal features for mania, interventions initiated prior to onset of the disorder (primary prevention) or early in the course of the disorder (early or secondary prevention) must be safe and well tolerated upon long-term exposure. Indeed, antidepressant and psychostimulant medications may precipitate the onset of mania. Although mood stabilizers and atypical antipsychotic medications exhibit efficacy in youth with bipolar I disorder, their efficacy for the treatment of prodromal mood symptoms is largely unknown. Moreover, mood stabilizers and atypical antipsychotics are associated with prohibitive treatment-emergent adverse effects. In contrast, omega-3 fatty acids have neurotrophic and neuroprotective properties and have been found to be efficacious, safe and well tolerated in the treatment of manic and depressive symptoms in children and adolescents. Together, extant evidence endorses a clinical staging model in which subjects at elevated risk for developing mania are treated with safer interventions (i.e. omega-3 fatty acids, family-focused therapy) in the prodromal phase, followed by pharmacological agents with potential adverse effects for nonresponsive cases and secondary prevention. This approach warrants evaluation in prospective longitudinal trials in youth determined to be at ultra-high risk for bipolar I disorder.