Chengappa K N Roy, Kupfer David J, Frank Ellen, Houck Patricia R, Grochocinski Victoria J, Cluss Patricia A, Stapf Debra A
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213-2593, USA.
Am J Psychiatry. 2003 Sep;160(9):1636-42. doi: 10.1176/appi.ajp.160.9.1636.
Utilizing data from a previously characterized registry of subjects with bipolar illness, the authors examined age at onset of the first illness episode in cohorts of subjects born from 1900 through 1939 and from 1940 through 1959.
Demographic and clinical characteristics at the first full episode of bipolar disorder of subjects in a diagnostically validated voluntary bipolar disorder registry (N=1,218) were reviewed and subjected to statistical analyses.
The median age at onset of the first episode of bipolar illness was lower by 4.5 years in subjects born during or after 1940 (median age=19 years), compared with subjects born before 1940 (median age=23.5 years). The proportion of subjects with bipolar disorder presenting with a prepubertal onset was significantly higher in the later birth-year cohort than in the earlier birth-year cohort. More than 50% of male and female subjects in both cohorts had a depressive episode as the first episode of bipolar illness. Subjects in each cohort who had a parent with major depression, bipolar disorder, or schizophrenia experienced their first episode nearly 4 to 5 years earlier than the other subjects in the cohort.
Prospective epidemiological studies conducted with bipolar disorder subjects are needed to either affirm or refute these data on age at illness onset. If the results are affirmed, the early recognition of prepubertal bipolar disorder will be important, so that the condition can be treated with appropriate medications and medications that could potentially worsen the illness course can be avoided. Similarly, early recognition of bipolar illness is important, especially in women, to minimize use of antidepressant monotherapy for patients with bipolar illness. Among young people presenting with major depression as the first illness episode, a parental history of major depression, bipolar disorder, or psychosis may be a useful pointer to future bipolar disorder. Early recognition and appropriate treatment of bipolar illness may prevent the development of chronicity and serious functional impairment.
利用来自一个先前已描述特征的双相情感障碍患者登记处的数据，作者研究了1900年至1939年出生队列以及1940年至1959年出生队列中首次发病的年龄。
回顾了一个经过诊断验证的自愿性双相情感障碍登记处（N = 1218）中双相情感障碍患者首次全面发作时的人口统计学和临床特征，并进行了统计分析。
与1940年之前出生的患者（中位年龄 = 23.5岁）相比，1940年及以后出生的患者双相情感障碍首次发作的中位年龄低4.5岁（中位年龄 = 19岁）。后出生年份队列中双相情感障碍青春期前发病的患者比例显著高于前出生年份队列。两个队列中超过50%的男性和女性患者以抑郁发作作为双相情感障碍的首次发作。每个队列中有父母患有重度抑郁症、双相情感障碍或精神分裂症的患者比队列中的其他患者首次发作时间早近4至5年。
需要对双相情感障碍患者进行前瞻性流行病学研究，以证实或反驳这些关于发病年龄的数据。如果结果得到证实，青春期前双相情感障碍的早期识别将很重要，以便可以用适当的药物进行治疗，并避免使用可能使病程恶化的药物。同样，双相情感障碍的早期识别很重要，尤其是对女性而言，以尽量减少双相情感障碍患者使用抗抑郁药单一疗法。在以重度抑郁症作为首次发病的年轻人中，父母有重度抑郁症、双相情感障碍或精神病病史可能是未来患双相情感障碍的有用指标。双相情感障碍的早期识别和适当治疗可能会预防慢性化和严重功能障碍的发展。
