Kim-Cohen Julia, Caspi Avshalom, Moffitt Terrie E, Harrington HonaLee, Milne Barry J, Poulton Richie
Institute of Psychiatry, King's College, London, England.
Arch Gen Psychiatry. 2003 Jul;60(7):709-17. doi: 10.1001/archpsyc.60.7.709.
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.
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, 21, 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.
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 schizophreniform 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.
Most adult disorders should be reframed as extensions of juvenile disorders. In particular, juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population.
如果发现大多数患有精神障碍的成年人有青少年精神病史，这将使病因学研究和预防政策更多地聚焦于儿童期精神障碍。
我们的前瞻性纵向研究对一个具有代表性的出生队列（N = 1037）进行了随访。我们依据《精神疾病诊断与统计手册》（DSM）标准在11岁、13岁、15岁、18岁、21岁和26岁时进行了精神疾病诊断。成人精神障碍按以下三种方式定义：（1）通过标准化诊断访谈确诊的病例；（2）接受治疗的子群体；（3）接受强化心理健康服务的子群体。回顾性分析确定了有青少年期诊断的成人病例的比例以及他们所患青少年期诊断的类型。
在通过诊断访谈表定义的成人病例中，73.9%在18岁之前被诊断，50.0%在15岁之前被诊断。在接受治疗的病例中，76.5%在18岁之前被诊断，57.5%在15岁之前被诊断。在接受强化心理健康服务的病例中，77.9%在18岁之前被诊断，60.3%在15岁之前被诊断。成人精神障碍通常在青少年期同类障碍之前出现（例如，成人焦虑症之前有青少年焦虑症），但也有不同的障碍。具体而言，成人焦虑症和精神分裂症样障碍之前有一系列广泛的青少年期障碍。对于所有成人精神障碍，25%至60%的病例有品行和/或对立违抗障碍病史。
大多数成人精神障碍应被重新界定为青少年精神障碍的延续。特别是，青少年品行障碍是减少成年人群体精神障碍的优先预防目标。
