Washington University School of Medicine, St. Louis, MO 63110, USA.
J Child Psychol Psychiatry. 2010 Apr;51(4):459-71. doi: 10.1111/j.1469-7610.2010.02210.x. Epub 2010 Jan 18.
Childhood bipolar disorder remains a controversial but increasingly diagnosed disorder that is associated with significant impairment, chronic course and treatment resistance. Therefore, the search for prodromes or early markers of risk for later childhood bipolar disorder may be of great importance for prevention and/or early identification.
Literature searches were conducted to identify reviews, case reports and empirical papers addressing the issue of prodromes of childhood bipolar disorder.
A total of 54 articles were found that related to bipolar prodromes, risk factors for later childhood bipolar disorder, childhood risk for adult bipolar disorder, mania manifestations in early childhood, and neuropsychological and biological markers of childhood bipolar disorder. A review of articles suggest (a) childhood bipolar prodromes may be detectable prior to the onset of the disorder, (b) prodromal symptoms may display episodicity during childhood, (c) there is evidence of possible endophenotypic markers such as deficits in executive function, sustained attention, and emotion labeling, (d) there is a potential association with functional, structural, and biochemical alterations evident in brain structures involved in mood regulation, (e) a link between childhood bipolar disorder with early tempermental markers, such as emotional regulation and behavioral disinhibition and (f) there is some early but promising evidence of effective psychotherapeutic preventions.
There has been very limited investigation of early prodromes of childhood bipolar disorder. Based on the promising findings of prodromes as well as high-risk states and possible endophenotypic markers, more controlled and targeted investigations into the early markers of bipolar disorder appear warranted and potentially fruitful. Until such longitudinal studies with appropriate controls are conducted, specific markers for bipolar prodromes will remain elusive, although evidence suggests they are manifest in at least some subgroups. The finding of promising psychotherapeutic prevention programs underscores the need to find specific and sensitive markers of bipolar prodromes in childhood.
儿童双相情感障碍仍然是一个有争议但越来越被诊断出的障碍，它与显著的损伤、慢性病程和治疗抵抗有关。因此，寻找儿童双相情感障碍后期的前驱症状或早期风险标志物对于预防和/或早期识别可能非常重要。
进行文献检索，以确定涉及儿童双相情感障碍前驱症状、后期儿童双相情感障碍风险因素、儿童期成年双相情感障碍风险、儿童期早期躁狂表现以及儿童双相情感障碍的神经心理学和生物学标志物的综述、病例报告和实证论文。
共发现 54 篇与双相情感障碍前驱症状、后期儿童双相情感障碍的风险因素、儿童期成年双相情感障碍风险、儿童期早期躁狂表现以及儿童双相情感障碍的神经心理学和生物学标志物相关的文章。对这些文章的综述表明：（a）儿童双相情感障碍前驱症状可能在疾病发作前就可检测到；（b）前驱症状可能在儿童期呈现间歇性；（c）有证据表明可能存在内表型标志物，如执行功能、持续注意力和情绪标记缺陷；（d）在参与情绪调节的大脑结构中，存在与功能、结构和生物化学改变相关的潜在关联；（e）儿童双相情感障碍与早期气质标记（如情绪调节和行为抑制）之间存在联系；（f）有一些早期但有希望的有效心理治疗预防的证据。
对儿童双相情感障碍的早期前驱症状的研究非常有限。基于前驱症状以及高危状态和可能的内表型标志物的有希望的发现，对双相情感障碍的早期标志物进行更具控制性和针对性的研究似乎是必要的，并且可能是富有成效的。在进行此类具有适当对照的纵向研究之前，双相情感障碍前驱症状的具体标志物仍然难以捉摸，尽管有证据表明它们至少在某些亚组中表现出来。有希望的心理治疗预防计划的发现强调了在儿童期寻找双相情感障碍前驱症状的特异性和敏感性标志物的必要性。
