Psychosocial functioning among bipolar youth
Psychosocial functioning among bipolar youth
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DOI：
10.1016/j.jad.2008.07.001
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发表时间：
2009-04-01
影响因子：
6.6
通讯作者：
Keller, Martin
中科院分区：
文献类型：
--
作者：
Goldstein, Tina R.;Birmaher, Boris;Keller, Martin
背景：证据表明儿童和青少年双相情感障碍（BP）经历显著的功能障碍。然而，在这一人群中，人们对社会心理功能与疾病发作、人口统计学和临床变量之间的关系知之甚少。方法：纳入446例年龄在7 - 17岁的DSM-IV双相情感障碍患者，通过K-SADS进行双相情感障碍青年病程和结局（COBY）研究。青少年纵向间隔随访评估（A-LIFE）的心理社会功能表在研究开始时进行。结果：轻度到中度的社会心理障碍在工作（包括学术）、人际关系和整体功能领域都很明显。多变量分析表明，心理社会障碍的最强预测因子是青春期（与发病年龄无关）、当前情绪发作、当前情感症状严重程度、当前精神病症状和当前共病行为障碍。发作中的双相青年在检查的每个功能领域中都明显比部分缓解/恢复的青少年受损，并且对其功能的满意度较低。然而，部分缓解/恢复的BP青年报告了显著的社会心理障碍。局限性：局限性包括依赖患者和父母对心理社会功能的回顾性报告。此外，我们没有考虑社会心理和药物干预对功能的影响。结论：研究结果表明，儿童BP与发作期间和发作之间的心理社会功能显著损害相关，情绪发作期间的损害比部分缓解/恢复期间更大。此外，BP的功能损害似乎在青春期增加，与发病年龄无关。临床医生应仔细评估和处理情绪发作期间和之间的社会心理障碍，特别注意BP青少年的功能。(c) 2008 Elsevier B.V.版权所有
Background: Evidence indicates that children and adolescents with bipolar disorder (BP) experience significant functional impairment. However, little is known about the association between psychosocial functioning and episodes of illness, demographic, and clinical variables in this population.Methods: Subjects included 446 patients aged 7 to 17 diagnosed with DSM-IV bipolar disorder via the K-SADS for the Course and Outcome of Bipolar Youth (COBY) study. The Psychosocial Functioning Schedule of the Adolescent Longitudinal Interval Follow-Up Assessment (A-LIFE) was administered at study intake.Results: Mild to moderate levels of psychosocial impairment were evident in work (includes academics), interpersonal, and overall domains of functioning among BP youth. Multivariate analyses indicated that the strongest predictors of psychosocial impairment were adolescence (regardless of age of onset), current mood episode, current affective symptom severity, current psychotic symptoms, and current comorbid conduct disorder. Bipolar youth in-episode were significantly more impaired than those in partial remission/recovery in every functional domain examined and were less satisfied with their functioning. Yet, BP youth in partial remission/recovery reported significant psychosocial impairment.Limitations: Limitations include the reliance on patient and parent retrospective report of psychosocial functioning. Additionally, we did not account for the impact of psychosocial and pharmacological interventions on functioning.Conclusions: Findings suggest pediatric BP is associated with significant impairment in psychosocial functioning during and between episodes, with greater impairment during mood episodes than during partial remission/recovery. Additionally, functional impairment in BP appears to increase during adolescence regardless of age of onset. Clinicians should carefully assess and address psychosocial impairment during and between mood episodes, with particular attention to the functioning of BP adolescents. (c) 2008 Elsevier B.V. All rights reserved.