Prior juvenile diagnoses in adults with mental disorder - Developmental follow-back of a prospective-longitudinal cohort
Prior juvenile diagnoses in adults with mental disorder - Developmental follow-back of a prospective-longitudinal cohort
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DOI：
10.1001/archpsyc.60.7.709
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发表时间：
2003-07-01
影响因子：
--
通讯作者：
Poulton, R
中科院分区：
文献类型：
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作者：
Kim-Cohen, J;Caspi, A;Poulton, R
背景：如果大多数患有精神障碍的成年人被发现有青少年精神病史，这将改变病因学研究和预防政策，使其更多地关注儿童精神障碍。方法：我们的前瞻性纵向研究跟踪了具有代表性的出生队列(N=1037)。分别于11岁、13岁、15岁、18岁、21岁、26岁按DSM标准进行精神病学诊断。成人精神障碍的定义有以下3种方式：(1)使用标准化诊断面谈诊断的病例；(2)使用治疗的亚组；(3)接受强化精神卫生服务的亚组。结果：在通过诊断性访谈程序确定的成人病例中，73.9%的病例在18岁之前确诊，50.0%的病例在15岁之前确诊。在使用治疗的病例中，76.5%的人在18岁之前确诊，57.5%的人在15岁之前确诊。在接受强化精神卫生服务的患者中，77.9%的人在18岁之前得到诊断，60.3%的人在15岁之前得到诊断。成人障碍通常先于青少年(例如，青少年焦虑先于成人焦虑)，但也有不同的障碍。具体地说，在成人焦虑症和分裂相型障碍之前，出现了一系列广泛的青少年障碍。在所有成人障碍中，25%至60%的病例有行为和/或对立违抗性障碍的病史。结论：大多数成人障碍应被遏制为青少年障碍的延伸。特别是，青少年行为障碍是减少成年人口精神障碍的优先预防目标。
Background: If most adults with mental disorders are found to have a juvenile psychiatric history, this would shift etiologic research and prevention policy to focus more on childhood mental disorders.Method: Our prospective longitudinal study followed up a representative birth cohort (N = 1037). We made psychiatric diagnoses according to DSM criteria at 11, 13, 15, 18, 2 1, and 26 years of age. Adult disorders were defined in the following 3 ways: (1) cases diagnosed using a standardized diagnostic interview, (2) the subset using treatment, and (3) the subset receiving intensive mental health services. Follow-back analyses ascertained the proportion of adult cases who had juvenile diagnoses and the types of juvenile diagnoses they had.Results: Among adult cases defined via the Diagnostic Interview Schedule, 73.9% had received a diagnosis before 18 years of age and 50.0% before 15 years of age. Among treatment-using cases, 76.5% received a diagnosis before 18 years of age and 57.5% before 15 years of age. Among cases receiving intensive mental health services, 77.9% received a diagnosis before 18 years of age and 60.3% before 15 years of age. Adult disorders were generally preceded by their juvenile counterparts (eg, adult anxiety was preceded by juvenile anxiety), but also by different disorders. Specifically, adult anxiety and schizo-phreniform disorders were preceded by a broad array of juvenile disorders. For all adult disorders, 25% to 60% of cases had a history of conduct and/or oppositional defiant disorder.Conclusions: Most adult disorders should be refrained as extensions of juvenile disorders. In particular, juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population.