Clinical course of children and adolescents with bipolar spectrum disorders
Clinical course of children and adolescents with bipolar spectrum disorders
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DOI：
10.1001/archpsyc.63.2.175
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发表时间：
2006-02-01
影响因子：
--
通讯作者：
Keller, M
中科院分区：
文献类型：
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作者：
Birmaher, B;Axelson, D;Keller, M
背景：尽管双相情感障碍（BP）的发病率很高，但很少有研究前瞻性地研究了这种疾病在青少年中的病程。目的：评估儿童和青少年血压谱障碍（BP- i, BP- ii，以及未另行指定的[BP- nos]）的纵向病程。设计：采用纵向间隔随访评估法，平均每9个月对受试者进行一次访谈，随访时间为2年。地点：3所大学中心的门诊和住院病房。参与者：263名患有BP-I （n = 152）、BP-II （n = 19）和BP-NOS （n = 92）的儿童和青少年（平均年龄13岁）。主要结局指标：恢复和复发率，出现综合征或亚综合征情绪症状的周数，症状和极性的变化，以及结局的预测因子。结果：大约70%的BP患者从他们的指数发作中恢复，50%的患者至少有一次综合征复发，特别是抑郁发作。对每周情绪症状的分析显示，在60%的随访时间里，受试者出现症状或亚症状，症状有许多变化和极性变化，3%的时间出现精神病。20%的BP-II患者转化为BP-I， 25%的BP-NOS患者转化为BP-I或BP-II。早发性BP、BP- nos、情绪症状持续时间长、低社会经济地位和精神病与较差的预后和快速的情绪变化有关。比较BP-I青少年和BP-I成人的二次分析显示，青少年明显有更多的症状时间，有更多的混合/循环发作、情绪症状改变和极性转换。结论：青年人的血压谱障碍表现出连续的血压症状严重程度，从亚综合征到完全综合征，并伴有频繁的情绪波动。本研究结果为BP-NOS提供了初步验证。
Context: Despite the high morbidity associated with bipolar disorder (BP), few studies have prospectively studied the course of this illness in youth.Objective: To assess the longitudinal course of BP spectrum disorders (BP-I, BP-II, and not otherwise specified [BP-NOS]) in children and adolescents.Design: Subjects were interviewed, on average, every 9 months for an average of 2 years using the Longitudinal Interval Follow-up Evaluation.Setting: Outpatient and inpatient units at 3 university centers.Participants: Two hundred sixty-three children and adolescents (mean age, 13 years) with BP-I (n = 152), BP-II (n = 19), and BP-NOS (n = 92).Main Outcome Measures: Rates of recovery and recurrence, weeks with syndromal or subsyndromal mood symptoms, changes in symptoms and polarity, and predictors of outcome.Results: Approximately 70% of subjects with BP recovered from their index episode, and 50% had at least 1 syndromal recurrence, particularly depressive episodes. Analyses of weekly mood symptoms showed that 60% of the follow-up time, subjects had syndromal or subsyndromal symptoms with numerous changes in symptoms and shifts of polarity, and 3% of the time, psychosis. Twenty percent of BP-II subjects converted to BP-I, and 25% of BP-NOS subjects converted to BP-I or BP-II. Early-onset BP, BP-NOS, long duration of mood symptoms, low socioeconomic status, and psychosis were associated with poorer outcomes and rapid mood changes. Secondary analyses comparing BP-I youths with BP-I adults showed that youths significantly more time symptomatic and had more mixed/cycling episodes, mood symptom changes, and polarity switches.Conclusions: Youths with BP spectrum disorders showed a continuum of BP symptom severity from subsyndromal to full syndromal with frequent mood fluctuations. Results of this study provide preliminary validation for BP-NOS.