Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype
Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype
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DOI：
10.1176/appi.ajp.159.6.927
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发表时间：
2002-06-01
影响因子：
17.7
通讯作者：
Zimerman, B
中科院分区：
文献类型：
--
作者：
Geller, B;Craney, JL;Zimerman, B
目的：在青少年后期或成年期发作的双相情感障碍的纵向结局已有报道，但对儿童期发作的躁狂症的自然史知之甚少。本研究旨在提供青春期前和青春期早期双相情感障碍表型儿童的恢复和复发率和预测因素。方法：89例连续确诊的门诊受试者（平均年龄= 10.9岁[SD=2.7]）接受了全面的研究评估，包括在基线和6，12，基线后18和24个月。研究表型需要DSM-IV躁狂症，并将抑郁和/或夸大作为一个标准，以区分研究表型与基于与注意缺陷多动障碍的标准重叠的躁狂症诊断，并确保受试者具有躁狂症的两个主要特征中的至少一个（即，结果：躁狂症患者治愈率为65.2%，治愈后复发率为55.2%。平均恢复时间为36.0周（SD=25.0）。平均28.6周后复发（SD=13.2）。生活在一个完整的生物家庭显着预测率的恢复，和一个低水平的母亲温暖显着预测率的reproduction.Conclusions：这些科目的相对较差的结果可能与他们的表型相似的严重疾病的成人双相情感障碍谁有混合躁狂症，持续快速循环，精神病，和治疗抵抗性精神病理学。不能排除情绪稳定剂对儿童的有效性较低。虽然母亲的温暖作为一个预测的意义是一致的成人躁狂症的报告，完整的家庭作为一个预测的意义可能是独特的儿童躁狂症。
Objective: Longitudinal outcomes of bipolar disorder with onset in the late teenage years or in adulthood have been reported, but little is known about the natural history of childhood-onset mania This study sought to provide rates and predictors of recovery and relapse in children with a prepubertal and early adolescent bipolar disorder phenotype,Method: Eighty-nine consecutively ascertained outpatient subjects (mean age = 10.9 years [SD=2.7]) received comprehensive research assessments, including separate interviews of mothers about their children and of children about themselves, at baseline and at 6, 12, 18, and 24 months after baseline. The study phenotype required DSM-IV mania with elation and/or grandiosity as one criterion to distinguish the study phenotype from a diagnosis of mania based on criteria overlapping with those for attention deficit hyperactivity disorder and to ensure that subjects had at least one of the two cardinal features of mania (i.e., elation and/or grandiosity), Subjects were treated by their own community practitioners,Results: The proportions of subjects who recovered from mania and who relapsed after recovery were 65.2% and 55.2%, respectively. The mean time to recovery was 36.0 weeks (SD=25.0). Relapse occurred after a mean of 28.6 weeks (SD=13.2). Living with an intact biological family significantly predicted rate of recovery, and a low level of maternal warmth significantly predicted rate of relapse.Conclusions: The relatively poor outcomes of these subjects may be related to their phenotypic resemblance to severely ill adults with bipolar disorder who have mixed mania, continuous rapid cycling, psychosis, and treatment-resistant psychopathology. A lower level of effectiveness of mood stabilizers in children cannot be ruled out. Although the significance of maternal warmth as a predictor is consistent with reports in adult mania, the significance of intact family as a predictor may be unique to childhood mania.