Papolos Demitri, Hennen John, Cockerham Melissa S
The Juvenile Bipolar Research Foundation, 550 Ridgewood Road, Maplewood, NJ 07040, USA.
J Affect Disord. 2005 Jun;86(2-3):267-75. doi: 10.1016/j.jad.2005.02.012.
It has recently been suggested that indicators of suicidality in youth may differ for different diagnostic groups []. Aggression, impulsivity and risk-taking behaviors may be strong indicators of suicidality in children and adolescents with symptoms of bipolar disorder.
Parents completed the Child Bipolar Questionnaire (CBQ) via a secure, Internet-based data acquisition system. In multivariate modeling analyses, with age and sex as covariates, CBQ items that were most closely correlated with parent-reported suicide threat were identified. The strength of this multifactor association was then examined among subjects reported to have a community diagnosis of bipolar disorder compared to those who did not.
In order of strength of association, the CBQ items most closely correlated with parent-reported suicide threat were: hallucinations, cursing/foul language, low energy/withdrawal, imagery-gore/violence, destroys property, poor self-esteem, excessive risk-taking, and excessive anxiety/worry. Of these 8 CBQ items, 3 (low energy, poor self-esteem, and anxiety/worry) have a dysphoric orientation, but the items with the strongest associations are related to psychosis, aggression and impulsivity. The association of the 8 CBQ items with suicidal threats was found to be much stronger in subjects with a reported prior or current bipolar diagnosis, compared with all other subjects.
Child report data is not available. Parent report data has not yet been validated by research diagnostic interview.
The presence of aggression and impulsivity are importantly related to suicidal threats independently of the risk associated with dysphoria in children and adolescents who have been assigned a diagnosis of bipolar disorder or exhibit some symptoms of the disorder. This may have implications for treatment with antidepressant medication when the diagnosis of bipolar disorder may be present.
最近有研究表明，青少年自杀倾向的指标在不同诊断组中可能存在差异。攻击行为、冲动性和冒险行为可能是双相情感障碍症状儿童和青少年自杀倾向的强烈指标。
父母通过一个安全的基于互联网的数据采集系统完成儿童双相情感问卷（CBQ）。在多变量建模分析中，以年龄和性别作为协变量，确定与父母报告的自杀威胁最密切相关的CBQ项目。然后在报告有双相情感障碍社区诊断的受试者与未诊断的受试者中检查这种多因素关联的强度。
按关联强度排序，与父母报告的自杀威胁最密切相关的CBQ项目依次为：幻觉、咒骂/脏话、精力不足/退缩、血腥/暴力意象、破坏财产、自尊低下、过度冒险和过度焦虑/担忧。在这8个CBQ项目中，有3个（精力不足、自尊低下和焦虑/担忧）具有烦躁不安的倾向，但关联最强的项目与精神病、攻击行为和冲动性有关。与所有其他受试者相比，在报告有既往或当前双相情感障碍诊断的受试者中，发现这8个CBQ项目与自杀威胁的关联要强得多。
没有儿童报告数据。父母报告数据尚未通过研究诊断访谈进行验证。
攻击行为和冲动性的存在与自杀威胁密切相关，这与双相情感障碍诊断或表现出该障碍某些症状的儿童和青少年的烦躁不安风险无关。这可能对双相情感障碍可能存在时使用抗抑郁药物治疗有影响。
