Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
J Clin Psychiatry. 2010 Oct;71(10):1344-50. doi: 10.4088/JCP.09m05845gre. Epub 2010 Sep 7.
Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder. We aimed to examine the prevalence and correlates of comorbid anxiety disorders among youth with bipolar disorder.
As part of the Course and Outcome of Bipolar Youth study, 446 youth, ages 7 to 17 years, who met DSM-IV criteria for bipolar I disorder (n = 260) or bipolar II disorder (n = 32) or met operationalized criteria for bipolar disorder not otherwise specified (n = 154) were included. Subjects were evaluated for current and lifetime Axis I psychiatric disorders at intake using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime version, and standardized instruments were used to assess functioning and family history.
Forty-four percent (n = 194) of the sample met DSM-IV criteria for at least 1 lifetime anxiety disorder, most commonly separation anxiety (24%) and generalized anxiety disorders (16%). Nearly 20% met criteria for 2 or more anxiety disorders. Overall, anxiety disorders predated the onset of bipolar disorder. Subjects with bipolar II disorder were more likely than subjects with bipolar I disorder or bipolar disorder not otherwise specified to have a comorbid anxiety disorder. After adjusting for confounding factors, youth with bipolar disorder with anxiety were more likely to have bipolar II disorder; longer duration of mood symptoms; more severe ratings of depression; and family history of depression, hopelessness, and somatic complaints during their worst lifetime depressive episode than those without anxiety.
Comorbid anxiety disorders are common in youth with bipolar disorder, and they most often predate bipolar disorder onset. Bipolar II disorder, a family history of depression, and more severe lifetime depressive episodes distinguish youth with bipolar disorder with comorbid anxiety disorders from those without. Careful consideration should be given to the assessment of comorbid anxiety in youth with bipolar disorder.
焦虑障碍是双相障碍青少年中最常见的共病之一。我们旨在研究双相障碍青少年中合并焦虑障碍的患病率及其相关因素。
作为双相青年病程和结局研究的一部分，纳入了 446 名年龄在 7 至 17 岁之间的符合 DSM-IV 双相 I 型障碍（n=260）、双相 II 型障碍（n=32）或非特定双相障碍操作性标准（n=154）的青少年。在入组时使用儿童心境障碍和精神分裂症谱系及服务研究-儿童定式访谈（Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime version）评估当前和终生的轴 I 精神障碍，并使用标准化工具评估功能和家族史。
样本中 44%（n=194）符合 DSM-IV 标准，至少有 1 种终生焦虑障碍，最常见的是分离性焦虑（24%）和广泛性焦虑障碍（16%）。近 20%的患者符合 2 种或更多焦虑障碍的标准。总体而言，焦虑障碍先于双相障碍发作。与双相 I 型障碍或非特定双相障碍相比，双相 II 型障碍患者更有可能合并焦虑障碍。在调整混杂因素后，有焦虑障碍的双相障碍患者更有可能患有双相 II 型障碍；心境症状持续时间更长；抑郁严重程度评分更高；在最严重的一生中抑郁发作期间，有抑郁、绝望和躯体主诉的家族史。
合并焦虑障碍在双相障碍青少年中很常见，且通常先于双相障碍发作。双相 II 型障碍、抑郁家族史和更严重的一生中抑郁发作可将合并焦虑障碍的双相障碍患者与无焦虑障碍患者区分开来。在评估双相障碍青少年时，应仔细考虑合并焦虑障碍的评估。
