The poor prognosis of childhood-onset bipolar disorder
The poor prognosis of childhood-onset bipolar disorder
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DOI：
10.1016/j.jpeds.2006.10.070
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发表时间：
2007-05-01
影响因子：
5.1
通讯作者：
Luckenbaugh, David
中科院分区：
文献类型：
--
作者：
Leverich, Gabriele S.;Post, Robert M.;Luckenbaugh, David
目的：假设早发会导致更严重的疾病，我们将双相情感障碍的发病年龄作为一个潜在的病程改变因素进行研究。研究设计对480例经仔细诊断的成年双相情感障碍门诊患者（平均年龄42.5±11.6岁）的发病年龄、首次药物治疗时间和病程进行回顾性评分。临床医生对一年内的每日情绪波动进行了前瞻性评估。结果在480例患者中，14%的患者在儿童期发病（12岁或更小）；青少年（13至18岁）36%；成年早期（19至29岁）32%；在成年后期（30岁以后），这一比例为19%。儿童期发作的双相情感障碍与第一次治疗的长时间延迟有关，平均超过16年。儿童或青少年起病的患者回顾报告了更多的发作、更多的合并症和快速的循环；预期，他们表现出更严重的躁狂、抑郁和更少的时间。结论：本研究表明，儿童时期双相情感障碍的发病是常见的，并且与首次治疗的长时间延迟有关。医生和临床医生应该警惕儿童可能的双相情感障碍诊断，以期缩短开始治疗的时间，并可能改善其他不良病程。
Objective We examined age of onset of bipolar disorder as a potential course-of-iflness modifier with the hypothesis that early onset will engender more severe illness.Study design A total of 480 carefully diagnosed adult outpatients with bipolar disorder (mean age, 42.5 +/- 11.6 years) were retrospectively rated for age of illness onset, time to first pharmacotherapy, and course of illness. Clinicians prospectively rated daily mood fluctuations over I year.Results Of the 480 patients, 14% experienced onset in childhood (12 years or younger); 36% in adolescence (13 to 18 years); 32% in early adulthood (19 to 29 years); and 19% in late adulthood (after 30 years). Childhood-onset bipolar illness was associated with long delays to first treatment, averaging more than 16 years. The patients with childhood or adolescent onset reported more episodes, more comorbidities, and rapid cycling retrospectively; prospectively, they demonstrated more severe mania, depression, and fewer days wen.Conclusions This study demonstrates that childhood onset of bipolar disorder is common and is associated with long delays to first treatment. Physicians and clinicians should be alert to a possible bipolar diagnosis in children in hopes of shortening the time to initiating treatment and perhaps ameliorating the otherwise adverse course of illness.