Masi Gabriele, Perugi Giulio, Millepiedi Stefania, Mucci Maria, Toni Cristina, Bertini Nicoletta, Pfanner Chiara, Berloffa Stefano, Pari Cinzia
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
J Child Adolesc Psychopharmacol. 2006 Dec;16(6):679-85. doi: 10.1089/cap.2006.16.679.
This study on a large sample of unselected, consecutive children and adolescents referred to a third-level hospital who received a diagnosis of bipolar disorder (BD) was aimed at exploring whether childhood-onset BD, as compared with adolescent-onset BD, presents specific clinical features in terms of severity, functional impairment, course, prevalent mood, pattern of co-morbidity, and treatment outcome.
A total of 136 patients, 81 males (59.6%) and 55 females (40.4%), mean age 13.5 +/- 2.9 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnosis of BD according to a structured clinical interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL), were included in the study.
Eighty patients (58.8%) had a childhood-onset BD (before 12 years of age) and 56 (41.2%) had an adolescents-onset BD. Compared with the adolescent-onset BD, patients with childhood-onset were more frequently males and had a more frequent co-morbidity with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). An episodic course was found in only 42.5% of bipolar children, but 76.8% of youngsters with adolescent-onset BD. Severity, 6-month treatment outcome, prevalent mood (elated versus irritable), and co-morbid anxiety did not differentiate the two groups.
Our findings suggest that a very early age at onset may identify a form of BD with a more frequent subcontinuous course and a heavy co-morbidity with ADHD.
本研究针对大量未经挑选、连续就诊于三级医院且被诊断为双相情感障碍（BD）的儿童和青少年样本，旨在探讨儿童期起病的双相情感障碍与青少年期起病的双相情感障碍相比，在严重程度、功能损害、病程、优势心境、共病模式及治疗结局方面是否具有特定的临床特征。
共有136例患者纳入研究，其中男性81例（59.6%），女性55例（40.4%），平均年龄13.5±2.9岁。根据针对学龄儿童情感障碍和精神分裂症的结构化临床访谈表（现在和终生版，KSADS-PL），这些患者符合《精神障碍诊断与统计手册》第4版（DSM-IV）双相情感障碍的诊断标准。
80例患者（58.8%）为儿童期起病的双相情感障碍（12岁之前起病），56例（41.2%）为青少年期起病的双相情感障碍。与青少年期起病的双相情感障碍相比，儿童期起病的患者男性更为常见，且更常合并注意力缺陷/多动障碍（ADHD）和对立违抗障碍（ODD）。仅42.5%的双相情感障碍儿童有发作性病程，而青少年期起病的双相情感障碍青少年中有76.8%有发作性病程。严重程度、6个月治疗结局、优势心境（欣快与易激惹）及共病焦虑在两组之间并无差异。
我们的研究结果表明，起病年龄非常早可能预示着一种双相情感障碍形式，其病程更常为非连续性，且与ADHD共病严重。
