Biederman Joseph, Faraone Stephen V, Wozniak Janet, Mick Eric, Kwon Anne, Cayton Gabrielle A, Clark Sarah V
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
J Psychiatr Res. 2005 Nov;39(6):611-22. doi: 10.1016/j.jpsychires.2004.08.003.
To compare the prevalence, clinical correlates, and comorbidity among children and adolescents with bipolar disorder (BPD) assessed in the early 1990s (first cohort) with those evaluated over the last 7 years (second cohort).
Subjects were consecutively referred children (N=108) and adolescents (N=197) with a DSM-III-R BPD diagnosis, referred to a child psychiatry service and evaluated with identical structured assessment methods.
Mania was identified in 16% of referred youth in both age groups and cohorts; in both age groups and cohorts, the clinical picture was predominantly irritable and mixed, and the course was chronic. Youth with BPD in both age groups and cohorts frequently had comorbidity with ADHD, psychosis and anxiety disorders. They also had high rates of psychiatric hospitalization and evidence of severely impaired psychosocial functioning.
The consistency of clinical features of bipolar disorder seen across age groups (children vs. adolescents) and cohorts (early and late cohorts) over the past decade supports the hypothesis that BPD in the young is a severe condition afflicting a sizeable minority of referred youth. These findings replicate and extend our previous characterization of an early onset mania, which may represent a developmental subtype of BPD.
比较20世纪90年代早期评估的双相情感障碍（BPD）儿童及青少年（第一队列）与过去7年评估的儿童及青少年（第二队列）在患病率、临床关联因素及共病情况方面的差异。
研究对象为连续转诊至儿童精神科服务机构、被诊断为DSM-III-R双相情感障碍的儿童（N = 108）及青少年（N = 197），采用相同的结构化评估方法进行评估。
在两个年龄组及队列中，16%的转诊青少年被确诊为躁狂；在两个年龄组及队列中，临床表现主要为易激惹和混合状态，病程呈慢性。两个年龄组及队列中患有双相情感障碍的青少年常合并注意缺陷多动障碍（ADHD）、精神病性障碍及焦虑症。他们的精神科住院率也很高，且有心理社会功能严重受损的证据。
过去十年间，双相情感障碍的临床特征在不同年龄组（儿童与青少年）及队列（早期与晚期队列）中保持一致，这支持了以下假设：青少年双相情感障碍是一种严重疾病，影响了相当一部分转诊青少年。这些发现重复并扩展了我们之前对早发性躁狂的描述，早发性躁狂可能代表双相情感障碍的一种发育亚型。
