A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders.
A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders.
复制标题
DOI：
10.1001/archgenpsychiatry.2011.126
复制
发表时间：
2011-10
影响因子：
--
通讯作者：
Monahan PO
中科院分区：
文献类型：
--
作者：
Nurnberger JI Jr;McInnis M;Reich W;Kastelic E;Wilcox HC;Glowinski A;Mitchell P;Fisher C;Erpe M;Gershon ES;Berrettini W;Laite G;Schweitzer R;Rhoadarmer K;Coleman VV;Cai X;Azzouz F;Liu H;Kamali M;Brucksch C;Monahan PO
成人双相情感障碍（BP）的儿童前兆仍然是一个有争议的问题。报告精神疾病的终生患病率和早期临床预测因素，与对照组相比，先证者家庭与DSM-IV BP的后代。一项对BP和相关疾病风险个体的纵向前瞻性研究。我们报告初步（横断面和回顾性）的诊断和临床特征后，最佳估计程序。评估于2006年6月1日至2009年9月30日在美国4所大学医学中心进行。12至21岁的后代在家庭与先证者与BP（n=141，指定为病例）和年龄相似的后代的对照父母（n=91）。终身DSM-IV诊断为重度情感障碍（BP I型;双相情感障碍; BP II型;或重度抑郁症）。在平均年龄为17岁时，病例显示主要情感障碍的终生患病率为23.4%，而对照组为4.4%（P= 0.002，调整了年龄、性别、种族和兄弟姐妹之间的相关性）。病例组的BP患病率为8.5%，对照组为0%（校正后P= 0.007）。其他情感、焦虑、破坏性行为或物质使用障碍的患病率无显著差异。在表现为严重情感障碍的病例受试者（n=33）中，与无情绪障碍的病例相比，焦虑和外化障碍的风险增加。在病例组而非对照组中，儿童期诊断为焦虑障碍（相对危险度=2.6; 95%CI，1.1-6.3; P= 0.04）或外化障碍（3.6; 1.4-9.0; P= 0.007）可预测较晚发生严重情感障碍。儿童期焦虑和外部诊断可预测BP先证者家庭中青少年后代的主要情感疾病。
The childhood precursors of adult bipolar disorder (BP) are still a matter of controversy. To report the lifetime prevalence and early clinical predictors of psychiatric disorders in offspring from families of probands with DSM-IV BP compared with offspring of control subjects. A longitudinal, prospective study of individuals at risk for BP and related disorders. We report initial (cross-sectional and retrospective) diagnostic and clinical characteristics following best-estimate procedures. Assessment was performed at 4 university medical centers in the United States between June 1, 2006, and September 30, 2009. Offspring aged 12 to 21 years in families with a proband with BP (n=141, designated as cases) and similarly aged offspring of control parents (n=91). Lifetime DSM-IV diagnosis of a major affective disorder (BP type I; schizoaffective disorder, bipolar type; BP type II; or major depression). At a mean age of 17 years, cases showed a 23.4% lifetime prevalence of major affective disorders compared with 4.4% in controls (P=.002, adjusting for age, sex, ethnicity, and correlation between siblings). The prevalence of BP in cases was 8.5% vs 0% in controls (adjusted P=.007). No significant difference was seen in the prevalence of other affective, anxiety, disruptive behavior, or substance use disorders. Among case subjects manifesting major affective disorders (n=33), there was an increased risk of anxiety and externalizing disorders compared with cases without mood disorder. In cases but not controls, a childhood diagnosis of an anxiety disorder (relative risk=2.6; 95% CI, 1.1–6.3; P=.04) or an externalizing disorder (3.6; 1.4–9.0; P=.007) was predictive of later onset of major affective disorders. Childhood anxiety and externalizing diagnoses predict major affective illness in adolescent offspring in families with probands with BP.