Tillman Rebecca, Geller Barbara, Craney James L, Bolhofner Kristine, Williams Marlene, Zimerman Betsy
Department of Psychiatry, School of Medicine, Washington University St. Louis, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Am J Psychiatry. 2004 Jul;161(7):1278-84. doi: 10.1176/appi.ajp.161.7.1278.
A controversy regarding pediatric bipolar disorder is whether to use child in addition to parent informants. To investigate this issue, the authors conducted a study comparing separate child and parent interview data for child bipolar disorder.
Responses on the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia from 93 child and 93 parent informants were compared by using kappa statistics. Research nurses, blind to subject information, separately interviewed parents about their children and children about themselves. Different nurses were used for the parent and child in each family to avoid bias from the same research nurse interviewing a child after interviewing that child's parent. Mania was defined by DSM-IV criteria, with at least one of the two cardinal symptoms of mania (elated mood and/or grandiosity), to avoid diagnosing mania by symptoms that overlapped with those for attention deficit hyperactivity disorder (ADHD).
Parent-child concordance was poor to fair for all cardinal and noncardinal mania symptoms. Kappas were not significantly different by age within the 7-14-year-old age range.
Symptoms endorsed by just the child included substantial proportions of bipolar symptoms that have been shown to best differentiate mania from ADHD (i.e., elation, grandiosity, flight of ideas, racing thoughts, decreased need for sleep). These findings support the need for child informants in research on prepubertal and early adolescent bipolar disorder in children ages 7-14. Differences in mania symptom profiles between investigative groups may be, in part, due to whether child informants were assessed.
关于儿童双相情感障碍存在一个争议，即除了家长提供信息者之外是否还应采用儿童提供信息者。为了研究这个问题，作者进行了一项研究，比较了儿童双相情感障碍中儿童和家长单独访谈的数据。
采用kappa统计量比较了来自93名儿童和93名家长提供信息者对圣路易斯华盛顿大学儿童情感障碍和精神分裂症量表的回答。对受试者信息不知情的研究护士分别就孩子的情况访谈家长以及就他们自己的情况访谈孩子。每个家庭的家长和孩子由不同的护士访谈，以避免同一名研究护士在访谈孩子的家长之后再访谈该孩子而产生偏差。躁狂症按照《精神疾病诊断与统计手册》第四版（DSM-IV）标准进行定义，具备至少两种躁狂症主要症状（欣快情绪和/或夸大观念）中的一种，以避免通过与注意缺陷多动障碍（ADHD）重叠的症状来诊断躁狂症。
对于所有主要和非主要的躁狂症状，亲子一致性较差到一般。在7至14岁年龄范围内，kappa值在不同年龄之间无显著差异。
仅由儿童认可的症状中，有很大比例的双相症状已被证明最能区分躁狂症和ADHD（即欣快、夸大观念、思维奔逸、思绪 racing thoughts、睡眠需求减少）。这些发现支持在7至14岁儿童青春期前和青春期早期双相情感障碍研究中需要儿童提供信息者。研究组之间躁狂症状特征的差异可能部分归因于是否评估了儿童提供信息者。
