The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents
The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents
复制标题
DOI：
10.1111/j.1399-5618.2007.00421.x
复制
发表时间：
2007-12-01
影响因子：
5.4
通讯作者：
Grof, Paul
中科院分区：
文献类型：
--
作者：
Duffy, Anne;Alda, Martin;Grof, Paul
这项纵向高风险研究的主要目的是在特征良好的父母的后代中确定新出现双相情感障碍 (BD) 的可靠早期指标。高风险后代是从其中一位父母根据情感障碍和精神分裂症时间表 - 终生版 (SADS-L) 访谈和 DSM-IV 诊断标准诊断为双相情感障碍且另一位父母状况良好的家庭中招募的。根据对长期锂的反应或无反应，双相父母被进一步细分。对照组的后代是从根据 SADS-L 访谈或家族史方法诊断的健康父母中招募的。来自高风险和对照家庭的所有同意的后代均使用学龄儿童情感障碍和精神分裂症时间表 - 当前和终生版本（KSADS-PL）进行纵向评估，并在盲法共识审查中做出 DSM-IV 诊断。平均每年对后代进行重新评估，并在症状出现的任何时候进行重新评估。两个高危群体中双相情感障碍的先决条件包括睡眠障碍和焦虑障碍，而注意力缺陷多动障碍和前精神病状态仅是锂盐无反应者的后代的先决条件。在那些患有双相情感障碍的后代中，指数情绪发作几乎总是抑郁。尽管存在特定的遗传风险，但大多数后代的双相情感障碍始于非特异性精神病理学和/或抑郁症。因此，仅基于症状的横断面评估的诊断似乎不足以准确及早发现新出现的双相情感障碍。应考虑其他参数，例如家族史和相关背景。
A major aim of this longitudinal high-risk study is to identify reliable early indicators of emerging bipolar disorder (BD) among offspring from well-characterized parents.High-risk offspring were recruited from families in which one parent had BD diagnosed on the basis of the Schedule for Affective Disorders and Schizophrenia - Lifetime version (SADS-L) interviews and DSM-IV diagnostic criteria and the other parent was well. Bipolar parents were further subdivided on the basis of response or non-response to long-term lithium. A comparison group of offspring was recruited from well parents diagnosed on the basis of either SADS-L interviews or the family history method. All consenting offspring from high-risk and control families were assessed longitudinally with the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime version (KSADS-PL) interviews and DSM-IV diagnoses were made on a blind consensus review. The offspring were reassessed on average annually, as well as at any time symptoms developed.Antecedent conditions to BD in both high-risk groups included sleep and anxiety disorders, while attention-deficit hyperactivity disorder and pre-psychotic conditions were antecedents among the offspring of lithium non-responders only. Among those offspring developing BD, the index mood episode was almost always depressive.Despite a specific genetic risk, BD began with non-specific psychopathology and/or depressive disorders in a majority of offspring. Therefore, diagnosis based only on cross-sectional assessment of symptoms appears to be insufficient for the accurate early detection of emerging BD. Other parameters such as family history and associated antecedents should be taken into account.