Wozniak Janet, Biederman Joseph, Kwon Anne, Mick Eric, Faraone Stephen, Orlovsky Kristin, Schnare Lauren, Cargol Christine, van Grondelle Anne
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Biol Psychiatry. 2005 Oct 1;58(7):583-8. doi: 10.1016/j.biopsych.2005.08.014. Epub 2005 Sep 28.
The main goal of this study was to test whether the hypothesized cardinal symptom of euphoria results in differences in clinical correlates in bipolar youth ascertained with no a priori assumptions about cardinal symptoms.
Subjects (n = 86) satisfying DSM-IV criteria for bipolar disorder with and without the proposed cardinal symptom of euphoria were compared in their bipolar symptom pattern, functioning and patterns of comorbidity.
Among Criterion A (abnormal mood), we found that severe irritability was the predominant abnormal mood rather than euphoria (94% vs. 51%). We also found that among Criterion B items, grandiosity was not uniquely overrepresented in youth with mania, nor did the rate of grandiosity differ whether irritability or irritability and euphoria were the Criterion A mood symptom. Neither symptom profile, patterns of comorbidity nor measures of functioning differed related to the presence or absence of euphoria.
These findings challenge the notion that euphoria represents a cardinal symptom of mania in children. Instead they support the clinical relevance of severe irritability as the most common presentation of mania in the young. They also support the use of unmodified DSM-IV criteria in establishing the diagnosis of mania in pediatric populations.
本研究的主要目的是检验在对首要症状没有先验假设的情况下，所假设的躁狂症首要症状欣快感是否会导致双相情感障碍青少年在临床相关因素上存在差异。
比较了86名符合DSM-IV双相情感障碍标准且有或无所提议的欣快感首要症状的受试者在双相情感症状模式、功能及共病模式方面的情况。
在A标准（异常情绪）方面，我们发现严重易激惹是主要的异常情绪而非欣快感（94%对51%）。我们还发现，在B标准项目中，夸大观念在躁狂症青少年中并非唯一过度出现，无论易激惹还是易激惹与欣快感都是A标准情绪症状时，夸大观念的发生率也没有差异。欣快感的有无与症状特征、共病模式及功能测量均无关。
这些发现挑战了欣快感是儿童躁狂症首要症状这一观念。相反，它们支持了严重易激惹作为青少年躁狂症最常见表现的临床相关性。它们还支持在儿科人群中使用未经修改的DSM-IV标准来诊断躁狂症。
