Craney James L, Geller Barbara
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
Bipolar Disord. 2003 Aug;5(4):243-56. doi: 10.1034/j.1399-5618.2003.00044.x.
Phenomenology, assessment, longitudinal, and psychosocial findings from an ongoing, controlled, prospective study of 93 subjects with a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) will be reviewed.
Unlike adult-onset bipolar disorder, for which there were over 50 years of systematic investigations, there were a paucity of rigorous data and much controversy and skepticism about the existence and characteristics of prepubertal-onset mania. With this background, issues to address for investigation of child-onset mania included the following: (i) What to do about the differentiation of mania from attention-deficit hyperactivity disorder (ADHD). (ii) How to deal with the ubiquity of irritability as a presenting symptom in multiple child psychiatry disorders. (iii) Development of a research instrument to assess prepubertal manifestations of adult mania (i.e. children do not 'max out' credit cards or have four marriages). (iv) How to distinguish normal childhood happiness and expansiveness from pathologically impairing elated mood and grandiosity.
To address these issues, a PEA-BP phenotype was defined as DSM-IV mania with elated mood and/or grandiosity as one inclusion criterion. This criterion ensured that the diagnosis of mania was not made using only criteria that overlapped with those for ADHD, and that subjects had at least one of the two cardinal symptoms of mania (i.e. elated mood and grandiose behaviors). Subjects were aged 10.9 years (SD = 2.6) and age of onset of the current episode at baseline was 7.3 years (SD = 3.5). Validation of PEA-BP was shown by reliable assessment, 6-month stability, and 1- and 2-year diagnostic longitudinal outcome. PEA-BP resembled the severest form of adult-onset mania by presenting with a chronic, mixed mania, psychotic, continuously (ultradian) cycling picture.
Counterintuitively, typical 7-year-old children with PEA-BP were more severely ill than typical 27 year olds with adult-onset mania. Moreover, longitudinal data strongly supported differentiation of PEA-BP from ADHD.
对一项正在进行的、对照的、前瞻性研究中93例患有青春期前及青春期早期双相情感障碍表型（PEA-BP）的受试者的现象学、评估、纵向研究及社会心理研究结果进行综述。
与有超过50年系统研究的成人起病双相情感障碍不同，青春期前起病躁狂症的存在及特征方面缺乏严格的数据，且存在诸多争议和怀疑。在此背景下，儿童起病躁狂症研究需解决的问题包括：（i）如何区分躁狂症与注意力缺陷多动障碍（ADHD）。（ii）如何处理易激惹在多种儿童精神疾病中作为主要症状的普遍性。（iii）开发一种研究工具以评估青春期前成人躁狂症的表现（即儿童不会“刷爆”信用卡或有四次婚姻）。（iv）如何区分正常儿童的快乐和外向与病理性的欣快情绪和夸大。
为解决这些问题，将PEA-BP表型定义为以欣快情绪和/或夸大作为一项纳入标准的DSM-IV躁狂症。该标准确保躁狂症的诊断不只是基于与ADHD重叠的标准，且受试者至少有躁狂症的两项主要症状之一（即欣快情绪和夸大行为）。受试者年龄为10.9岁（标准差=2.6），基线时当前发作的起病年龄为7.3岁（标准差=3.5）。通过可靠评估、6个月稳定性以及1年和2年诊断纵向结果显示了PEA-BP的有效性。PEA-BP表现为慢性、混合性躁狂、精神病性、持续（超日节律）循环状态，类似于成人起病躁狂症最严重的形式。
与直觉相反，患有PEA-BP的典型7岁儿童比患有成人起病躁狂症的典型27岁成人病情更严重。此外，纵向数据有力地支持了PEA-BP与ADHD的区分。
