Mick Eric, Biederman Joseph, Faraone Stephen V, Murray Kate, Wozniak Janet
Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Child Adolesc Psychopharmacol. 2003 Winter;13(4):453-62. doi: 10.1089/104454603322724841.
To test the hypothesis that the age at onset of bipolar disorder would identify a developmental subtype of bipolar disorder in adults characterized by increased levels of irritability, chronic course, rapid cycling, and comorbidity with attention deficit hyperactivity disorder.
Forty-four adult subjects diagnosed with bipolar disorder were selected from large family studies of youth with and without attention deficit hyperactivity disorder. These subjects were stratified by the age at onset in childhood (younger than 13 years; n = 8, 18%), adolescence (13-18 years; n = 12, 27%, or adulthood (older than 19 years; n = 24, 55%). All subjects were administered structure diagnostic interviews and a brief cognitive battery.
In contrast with adult-onset bipolar disorder, child-onset bipolar disorder was associated with a longer duration of illness, more irritability than euphoria, a mixed presentation, a more chronic or rapid-cycling course, and increased comorbidity with childhood disruptive behavior disorders and anxiety disorders.
Stratification by age at onset of bipolar disorder identified subgroups of adult subjects with differing clinical correlates. This pattern of correlates is consistent with findings documented in children with pediatric bipolar disorder and supports the hypothesis that child-onset bipolar disorder may represent a developmental subtype of the disorder.
检验以下假设，即双相情感障碍的起病年龄可确定成人双相情感障碍的一种发育亚型，其特征为易激惹程度增加、病程慢性化、快速循环发作以及与注意力缺陷多动障碍共病。
从有和没有注意力缺陷多动障碍的青少年的大型家族研究中选取44名被诊断为双相情感障碍的成年受试者。这些受试者按儿童期起病年龄（小于13岁；n = 8，18%）、青春期起病年龄（13 - 18岁；n = 12，27%）或成年期起病年龄（大于19岁；n = 24，55%）进行分层。所有受试者均接受结构化诊断访谈和简短认知测试。
与成年期起病的双相情感障碍相比，儿童期起病的双相情感障碍与病程更长、易激惹多于欣快感、混合发作形式、更慢性或快速循环发作病程以及与儿童期破坏性行为障碍和焦虑症共病增加相关。
按双相情感障碍起病年龄分层可确定具有不同临床关联的成年受试者亚组。这种关联模式与儿童双相情感障碍的研究结果一致，并支持儿童期起病的双相情感障碍可能代表该疾病一种发育亚型的假设。
