Geller Barbara, Zimerman Betsy, Williams Marlene, Delbello Melissa P, Bolhofner Kristine, Craney James L, Frazier Jeanne, Beringer Linda, Nickelsburg Michael J
Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri 63110, USA.
J Child Adolesc Psychopharmacol. 2002 Spring;12(1):11-25. doi: 10.1089/10445460252943533.
To compare the prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) to those with attention deficit hyperactivity disorder (ADHD) and normal community controls (CC).
To optimize generalizeability, subjects with PEA-BP and ADHD were consecutively ascertained from outpatient pediatric and psychiatric sites, and CC subjects were obtained from a random survey. All 268 subjects (93 with PEA-BP, 81 with ADHD, and 94 CC) received comprehensive, blind, baseline research assessments of mothers about their children and of children about themselves. PEA-BP was defined by DSM-IV mania with elation and/or grandiosity as one criterion to ensure that subjects had one of the two cardinal symptoms of mania and to avoid diagnosing mania only by criteria that overlapped with those for ADHD.
Five symptoms (i.e., elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep, and hypersexuality) provided the best discrimination of PEA-BP subjects from ADHD and CC controls. These five symptoms are also mania-specific in DSM-IV (i.e., they do not overlap with DSM-IV symptoms for ADHD). Irritability, hyperactivity, accelerated speech, and distractibility were very frequent in both PEA-BP and ADHD groups and therefore were not useful for differential diagnosis. Concurrent elation and irritability occurred in 87.1% of subjects with PEA-BP. Data on suicidality, psychosis, mixed mania, and continuous rapid cycling were also provided.
Unlike late teenage/adult onset bipolar disorder, even subjects with PEA-BP selected for DSM-IV mania with cardinal symptoms have high rates of comorbid DSM-IV ADHD. High rates of concurrent elation and irritability were similar to those in adult mania.
比较《精神疾病诊断与统计手册》第四版（DSM-IV）中，青春期前及青春期早期双相情感障碍表型（PEA-BP）患者的躁狂症状患病率与注意力缺陷多动障碍（ADHD）患者及正常社区对照（CC）的患病率。
为优化普遍性，从儿科和精神科门诊连续确定PEA-BP和ADHD患者，CC受试者通过随机调查获得。所有268名受试者（93名PEA-BP患者、81名ADHD患者和94名CC受试者）接受了母亲对其子女以及子女对自身的全面、盲法基线研究评估。PEA-BP由DSM-IV躁狂症定义，以欣快和/或夸大作为一项标准，以确保受试者具有躁狂症的两种主要症状之一，并避免仅根据与ADHD重叠的标准来诊断躁狂症。
五种症状（即欣快、夸大、思维奔逸/思绪 racing thoughts、睡眠需求减少和性欲亢进）能最好地区分PEA-BP受试者与ADHD和CC对照。这五种症状在DSM-IV中也是躁狂症特有的（即它们与DSM-IV中ADHD的症状不重叠）。易怒、多动、语速加快和注意力分散在PEA-BP和ADHD组中都非常常见，因此对鉴别诊断没有帮助。87.1%的PEA-BP受试者同时出现欣快和易怒。还提供了关于自杀倾向、精神病、混合性躁狂和持续性快速循环的数据。
与青少年晚期/成人期双相情感障碍不同，即使是因具有主要症状而被选择为DSM-IV躁狂症的PEA-BP患者，共病DSM-IV ADHD的发生率也很高。同时出现欣快和易怒的高发生率与成人躁狂症相似。
