Early stages in the development of bipolar disorder
Early stages in the development of bipolar disorder
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DOI：
10.1016/j.jad.2009.05.022
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发表时间：
2010-02-01
影响因子：
6.6
通讯作者：
Grof, Paul
中科院分区：
文献类型：
--
作者：
Duffy, Anne;Alda, Martin;Grof, Paul
背景：许多研究已经观察到双相父母的后代表现出广泛的精神障碍。我们检验了这一假设，即在高危子女中，双相情感障碍以可预测的临床序列从非特定(非情绪)到特定(情绪)精神病理演变。方法：采用KSADS-PL访谈，每年或随时使用KSADS-PL访谈评估具有良好特征的单亲(高危)或双亲良好(对照)家庭的子女出现症状的时间长达15年。对DSM-IV的诊断进行油盲共识回顾，使用所有可用的临床资料。我们比较了高危受试者和对照受试者终生精神病理学的年龄调整风险，并评估了在有非情绪障碍病史的情况下发生情绪障碍的条件概率。在符合双相情感障碍的完整DSM-IV标准的受试者中，我们对照临床分期模型评估了精神病理学序列。结果：与对照组相比，高危子女表现出更高的焦虑和睡眠障碍以及主要的情绪和药物使用障碍的发生率。前期焦虑将年龄调整后的情绪障碍风险从40%增加到85%(风险比为2.6)。患有情绪障碍的高危受试者患药物使用障碍的风险增加(风险比为2.4)，通常在第一次重大情绪发作期间或之后符合诊断标准。导致双相情感障碍的精神病理学的演变一般遵循所提出的顺序，尽管并不是所有受试者都表现出所有阶段。限制：在风险期间前瞻性评估更多的高危子女将允许确认这些初步发现。结论：临床分期可能是完善双相情感障碍早期诊断和促进对有家族风险的双相情感障碍演变的研究的有用方法。(C)2009爱思唯尔B.V.保留所有权利。
Background: Numerous studies have observed that offspring of bipolar parents manifest a broad spectrum of psychiatric disorders. We tested the hypothesis that in high risk offspring, bipolar disorder evolves in a predictable clinical sequence from non-specific (non-mood) to specific (mood) psychopathology.Methods: Offspring from well-characterized families with one bipolar parent (high risk) or two well parents (controls) were assessed annually or at anytime symptoms developed using KSADS-PL interviews for Up to 15 years. DSM-IV diagnoses were made oil blind consensus review using all available clinical material. We compared the age-adjusted risks of lifetime psychopathology between high risk and control Subjects and assessed the conditional probability of developing a mood disorder given a history of non-mood disorders. In subjects meeting full DSM-IV criteria for bipolar disorder, we assessed the sequence of psychopathology against a clinical staging model.Results: High risk offspring manifest higher rates of anxiety and sleep disorders, as well as major mood and substance use disorders compared to controls. Antecedent anxiety increased the age-adjusted risk of mood disorder from 40 to 85% (hazard ratio of 2.6). High risk Subjects who developed a mood disorder had an increased risk of a substance use disorder (hazard ratio of 2.4), typically meeting diagnostic criteria during or after the first major mood episode. The evolution of psychopathology leading to bipolar disorder generally followed the proposed sequence, although not all subjects manifest all stages.Limitations: Larger numbers of high risk offspring prospectively assessed over the risk period would allow confirmation of these preliminary findings.Conclusions: Clinical staging may be a useful approach to refine the early diagnosis and facilitate research into the evolution of bipolar disorder in those at familial risk. (C) 2009 Elsevier B.V. All rights reserved.