Birmaher Boris, Axelson David
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
Dev Psychopathol. 2006 Fall;18(4):1023-35. doi: 10.1017/S0954579406060500.
The longitudinal course of children and adolescents with bipolar disorder (BP) is manifested by frequent changes in symptom polarity with a fluctuating course showing a dimensional continuum of bipolar symptom severity from subsyndromal to mood syndromes meeting full Diagnostic and Statistical Manual of Mental Disorders criteria. These rapid fluctuations in mood appear to be more accentuated than in adults with BP, and combined with the high rate of comorbid disorders and the child's cognitive and emotional developmental stage, may explain the difficulties encountered diagnosing and treating BP youth. Children and adolescents with early-onset, low socioeconomic status, subsyndromal mood symptoms, long duration of illness, rapid mood fluctuation, mixed presentations, psychosis, comorbid disorders, and family psychopathology appear to have worse longitudinal outcome. BP in children and adolescents is associated with high rates of hospitalizations, psychosis, suicidal behaviors, substance abuse, family and legal problems, as well as poor psychosocial functioning. These factors, in addition to the enduring and rapid changeability of symptoms of this illness from very early in life, and at crucial stages in their lives, deprive BP children of the opportunity for normal psychosocial development. Thus, early recognition and treatment of BP in children and adolescents is of utmost importance.
双相情感障碍（BP）儿童和青少年的病程表现为症状极性频繁变化，病程波动，呈现出从亚综合征到符合《精神疾病诊断与统计手册》全部标准的情绪综合征的双相症状严重程度的维度连续体。与双相情感障碍成人患者相比，这些情绪的快速波动似乎更为明显，再加上共病率高以及儿童的认知和情感发育阶段的因素，可能解释了诊断和治疗双相情感障碍青少年时遇到的困难。起病早、社会经济地位低、有亚综合征情绪症状、病程长、情绪波动快、混合症状表现、精神病性症状、共病以及家庭精神病理学问题的儿童和青少年，其纵向预后似乎更差。儿童和青少年双相情感障碍与高住院率、精神病性症状、自杀行为、物质滥用、家庭和法律问题以及心理社会功能不良有关。这些因素，再加上这种疾病从生命早期以及在他们生命的关键阶段症状的持续性和快速变化性，剥夺了双相情感障碍儿童正常心理社会发展的机会。因此，儿童和青少年双相情感障碍的早期识别和治疗至关重要。
