Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, University of Navarra Clinic (Madrid Campus), Madrid, Spain.
J Affect Disord. 2011 Jul;132(1-2):270-4. doi: 10.1016/j.jad.2011.01.013. Epub 2011 Feb 18.
Bipolar disorder (BD) often starts in childhood or adolescence. There is considerable scepticism outside the United States over the validity, stability and prevalence of BD in children and adolescents. Persistence of course lends support to the validity of a diagnosis.
To describe the longitudinal course of pediatric BD in a Spanish sample over a median follow-up period of 2.6years and to examine risk factors associated with outcome.
We retrospectively reviewed the medical records of all children and adolescents (N=38) with DSM-IV-TR BD-I, II and NOS evaluated in the Child and Adolescent Psychiatry Unit, University of Navarra (Pamplona, Spain) from 1999 to 2005. We used the NIMH Lifetime Mood Chart and the Clinical Global Impression-Severity Scale to assess clinical course.
79% (N=30) were boys and 21% (N=8) were girls; 44.7% (N=17) had BD-I, 5.3% (N=2) BD-II, and 50% (N=19) BD-NOS. Median (inter-quartile range: IQR: Q25; Q75) age at diagnosis was 13.9 (10.64; 15.84). Median follow-up period was 2.6years (0.91; 3.66). Mean percentage of time in an episode was 46.17% (23.36; 75.26), and it was longer in younger children (p<0.05). 2.6% had rapid cycling. At the end of follow-up, only 47% achieved remission or recovery. Younger children showed a worse treatment response (p<0.05). We found higher rates of hospitalization in children with ADHD (21%) (p<0.05).
Children with BD had a chronic course with little interepisodic recovery. BD can be diagnosed in children using DSM-IV-TR criteria. An early age of onset and ADHD comorbidity are risk factors for worse prognosis.
双相情感障碍（BD）通常始于儿童或青少年时期。在美国以外，对于儿童和青少年中 BD 的有效性、稳定性和普遍性存在相当大的怀疑。病程的持续为诊断的有效性提供了支持。
描述西班牙样本中儿科 BD 的纵向病程，中位随访时间为 2.6 年，并检查与结局相关的风险因素。
我们回顾性审查了 1999 年至 2005 年期间在纳瓦拉大学儿童和青少年精神病学系（西班牙潘普洛纳）接受 DSM-IV-TR BD-I、II 和 NOS 评估的所有儿童和青少年（N=38）的病历。我们使用 NIMH 终身情绪图表和临床总体印象严重程度量表来评估临床病程。
79%（N=30）为男性，21%（N=8）为女性；44.7%（N=17）患有 BD-I，5.3%（N=2）患有 BD-II，50%（N=19）患有 BD-NOS。诊断时的中位（四分位距：IQR：Q25；Q75）年龄为 13.9（10.64；15.84）。中位随访期为 2.6 年（0.91；3.66）。发作期的平均时间百分比为 46.17%（23.36；75.26），在年龄较小的儿童中时间更长（p<0.05）。2.6%的患者为快速循环。随访结束时，仅有 47%的患者达到缓解或康复。年龄较小的儿童治疗反应较差（p<0.05）。我们发现患有注意力缺陷多动障碍（ADHD）的儿童住院率较高（21%）（p<0.05）。
BD 患儿病程呈慢性，发作间期很少有缓解。DSM-IV-TR 标准可用于诊断儿童 BD。发病年龄较早和 ADHD 共病是预后较差的危险因素。
