Bhangoo Robinder K, Dell Mary Lynn, Towbin Kenneth, Myers Frances S, Lowe Catherine H, Pine Daniel S, Leibenluft Ellen
The Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
J Child Adolesc Psychopharmacol. 2003 Winter;13(4):507-14. doi: 10.1089/104454603322724896.
Researchers debate whether the diagnostic criteria for mania should differ between children and adults. Specifically, although the Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV) requires episodic mood changes, children commonly are diagnosed as manic on the basis of chronic irritability. In this preliminary study, children carrying a diagnosis of bipolar disorder (BPD) in the community were classified as having either episodic or chronic symptoms. We hypothesized that the episodic group would be more likely to have a history of psychosis and a parental history of BPD, whereas the chronic group would be more likely to have conduct disorder.
Parents of children carrying the BPD diagnosis were interviewed on the telephone to obtain psychiatric and family histories. Children were considered episodic (n = 34) if they had a history of one or more DSM-IV manic/hypomanic episodes meeting full duration criteria and chronic (n = 53) if they had no discernable episodes.
The episodic group was more likely to have had psychosis, parental history of BPD, and to have experienced each manic symptom except for irritability and psychomotor agitation. Children in the episodic group were also more likely to have had a depressive episode meeting full DSM-IV criteria and were more likely to have made a suicide attempt. Children in the chronic group were not more likely to meet criteria for conduct disorder but were more likely to exhibit violence toward others.
These preliminary data indicate that, among children being treated for BPD in the community, those with discrete episodes of mania may be more likely to have a lifetime history of psychosis and a parental history of BPD. The latter hypothesis should be tested in a sample where relatives are interviewed directly.
研究人员对儿童与成人躁狂症的诊断标准是否应有所不同存在争议。具体而言，尽管《精神疾病诊断与统计手册》（第四版；DSM-IV）要求有发作性情绪变化，但儿童通常基于慢性易激惹被诊断为躁狂。在这项初步研究中，社区中被诊断为双相情感障碍（BPD）的儿童被分类为有发作性或慢性症状。我们假设发作性症状组更可能有精神病病史和BPD家族史，而慢性症状组更可能有品行障碍。
对患有BPD诊断的儿童的父母进行电话访谈以获取精神病史和家族史。如果儿童有一次或多次符合完整病程标准的DSM-IV躁狂/轻躁狂发作史，则被视为发作性症状组（n = 34）；如果没有可识别的发作，则被视为慢性症状组（n = 53）。
发作性症状组更可能有精神病、BPD家族史，并且除易激惹和精神运动性激越外，经历过每种躁狂症状。发作性症状组的儿童也更可能有符合完整DSM-IV标准的抑郁发作，并且更可能有自杀企图。慢性症状组的儿童不太可能符合品行障碍标准，但更可能对他人表现出暴力行为。
这些初步数据表明，在社区中接受BPD治疗的儿童中，有离散躁狂发作的儿童可能更可能有终生精神病病史和BPD家族史。后一种假设应在直接访谈亲属的样本中进行检验。
