Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 3555 Harden St Ext, 15 Medical Park Ste 301, Columbia, SC 29203, USA.
J Clin Psychiatry. 2010 Nov;71(11):1518-25. doi: 10.4088/JCP.09m05585ora. Epub 2010 Jun 15.
To identify the association between medical or psychiatric comorbidities, clinical characteristics, or course of illness/recovery in pediatric bipolar disorder (BD).
Data from the South Carolina Medicaid program covering all medical services and medication prescriptions between January 1996 and December 2005 were used to analyze the temporal onset of 12 comorbid medical or psychiatric conditions for 1,841 children and adolescents diagnosed with BD using DSM-IV-TR criteria and for a random sample of 4,500 children not treated for psychiatric disorders. The primary outcome measures were diagnostic codes and regression analyses of patterns of acute and outpatient treatment services for BD over time.
Ten conditions examined were significantly more prevalent in the BD cohort: obesity, type 2 diabetes mellitus, endocrine disorders, migraine headaches, central nervous system (CNS) disorders/epilepsy, organic brain disorders/mental retardation, cardiovascular disorders, attention-deficit/hyperactivity disorder (ADHD), asthma, and substance abuse (P ≤ .01). For clinical characteristics within the BD cohort, an adolescent-onset diagnosis of BD (age ≥13 years) was significantly associated with the diagnosis of preexisting obesity, hypertension, migraine, mental retardation, endocrine disorders, and substance abuse (P ≤ .05), whereas recurrent depressive episodes were associated with preexisting endocrine disorders and substance abuse. Preexisting ADHD, substance abuse, CNS disorders/epilepsy, cardiovascular disorders, obesity, and asthma were associated with higher overall medical and psychiatric outpatient and acute service use, but none of these comorbid disorders differentially impacted the course of illness or recovery for BD.
Neuropsychiatric (ie, ADHD, substance abuse, CNS disorders/epilepsy) and medical (ie, obesity, asthma, cardiovascular disease) disorders temporally precede the diagnosis of early-onset BD in pediatric patients and are associated with discrete facets of illness presentation, but they do not substantially alter the clinical course of the BD over time.
确定儿科双相情感障碍（BD）的合并症、临床特征或疾病/康复过程之间的关联。
利用南卡罗来纳州医疗补助计划（1996 年 1 月至 2005 年 12 月）的数据，对 1841 名符合 DSM-IV-TR 标准诊断为 BD 的儿童和青少年以及 4500 名未接受精神疾病治疗的随机抽样儿童，分析 12 种共患的医疗或精神疾病在时间上的发病情况。主要结局指标是诊断代码和回归分析随着时间的推移，BD 的急性和门诊治疗服务模式。
在 BD 组中，有 10 种疾病的发病率明显升高：肥胖症、2 型糖尿病、内分泌紊乱、偏头痛、中枢神经系统（CNS）疾病/癫痫、脑器质性疾病/智力迟钝、心血管疾病、注意力缺陷/多动障碍（ADHD）、哮喘和物质滥用（P≤0.01）。在 BD 组的临床特征中，青少年期起病的 BD（年龄≥13 岁）与先前存在的肥胖、高血压、偏头痛、智力迟钝、内分泌紊乱和物质滥用的诊断显著相关（P≤0.05），而反复的抑郁发作与先前存在的内分泌紊乱和物质滥用有关。先前存在的 ADHD、物质滥用、CNS 疾病/癫痫、心血管疾病、肥胖和哮喘与更高的整体医疗和精神科门诊和急性服务使用相关，但这些合并症没有一个对 BD 的疾病进程或康复产生显著影响。
神经精神疾病（即 ADHD、物质滥用、CNS 疾病/癫痫）和躯体疾病（即肥胖、哮喘、心血管疾病）在儿科患者中，BD 的早期发病之前出现，并与疾病表现的不同方面相关，但它们不会随着时间的推移而显著改变 BD 的临床病程。
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