Department of Psychology, The Catholic University of America, Washington, DC 20064, USA.
Postgrad Med. 2010 Jul;122(4):94-104. doi: 10.3810/pgm.2010.07.2177.
Despite low prevalence rates in epidemiological studies, recent research suggests that bipolar disorder (BD) is being diagnosed at increasingly high rates in children and adolescents. To clarify the nosological boundaries of the disorder, studies of the clinical presentation of bipolar youth should be complemented with examinations of cognitive and neural functioning. More specifically, delineating the neurocognitive functioning of youth with BD when processing emotional stimuli may best elucidate how certain emotional contexts elicit symptoms that characterize pediatric BD. This information has the potential to clarify causes of pediatric BD, and to confirm the diagnosis of BD in youth. In this article, we discuss the affective, behavioral, cognitive, and neurological functioning of youth with BD when processing emotional stimuli. We focus on studies that have employed paradigms involving pictures and words with emotional valence, faces with emotional expressions, and responses to reward and punishment. The most consistent results on behavior are from studies involving facial stimuli, which find that youth with BD display a tendency to mislabel face emotions. Neurological data demonstrate that emotion-processing deficits in pediatric BD involve dysfunction within a distributed fronto-striatal-limbic network, including the dorsolateral and ventrolateral prefrontal cortex, anterior cingulate cortex, striatum, and amygdala. These data may begin to clarify why BD youth present with poor social functioning and deficits in regulating their affect and behavior.
尽管在流行病学研究中发病率较低，但最近的研究表明，双相情感障碍（BD）在儿童和青少年中的诊断率正在不断上升。为了明确该疾病的分类界限，对双相青年临床表现的研究应辅以认知和神经功能的检查。更具体地说，当处理情绪刺激时，描绘具有 BD 的青年的神经认知功能可以最好地阐明某些情绪环境如何引发特征性儿科 BD 的症状。这些信息有可能阐明儿科 BD 的病因，并在青年中确认 BD 的诊断。在本文中，我们讨论了处理情绪刺激时具有 BD 的青年的情感、行为、认知和神经功能。我们专注于涉及具有情感效价的图片和单词、具有情感表达的面孔以及对奖励和惩罚的反应的范式的研究。来自涉及面部刺激的研究的最一致的行为结果表明，BD 青年表现出错误标记面部情绪的倾向。神经学数据表明，儿科 BD 中的情绪处理缺陷涉及到额-纹状体-边缘网络内的功能障碍，包括背外侧和腹外侧前额叶皮层、前扣带皮层、纹状体和杏仁核。这些数据可能开始阐明为什么 BD 青年的社交功能不佳，并且在调节他们的情感和行为方面存在缺陷。
