University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Oct;50(10):1001-16.e3. doi: 10.1016/j.jaac.2011.07.005. Epub 2011 Sep 8.
To determine the rate of diagnostic conversion from an operationalized diagnosis of bipolar disorder not otherwise specified (BP-NOS) to bipolar I disorder (BP-I) or bipolar II disorder (BP-II) in youth over prospective follow-up and to identify factors associated with conversion.
Subjects were 140 children and adolescents recruited from clinical referrals or advertisement who met operationalized criteria for BP-NOS at intake and participated in at least one follow-up evaluation (91% of initial cohort). Diagnoses were assessed at follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. The mean duration of follow-up was 5 years and the mean interval between assessments was 8.2 months.
Diagnostic conversion to BP-I or BP-II occurred in 63 subjects (45%): 32 (23%) to BP-I (nine of whom had initially converted to BP-II) and 31 to only BP-II (22%). Median time from intake to conversion was 58 weeks. First- or second-degree family history of mania or hypomania was the strongest baseline predictor of diagnostic conversion (p = .006). Over follow-up, conversion was associated with greater intensity of hypomanic symptoms and with greater exposure to specialized, intensive outpatient psychosocial treatments. There was no association between conversion and exposure to treatment with particular medication classes.
Children and adolescents referred with mood symptoms that meet operationalized criteria for BP-NOS, particularly those with a family history of BP, frequently progress to BP-I or BP-II. Efforts to identify these youth and effectively intervene may have the potential to curtail the progression of mood disorders in this high-risk population.
在前瞻性随访中确定从操作性双相障碍未特定型（BP-NOS）诊断转为双相 I 型障碍（BP-I）或双相 II 型障碍（BP-II）的比率，并确定与转化相关的因素。
本研究纳入了 140 名儿童和青少年，他们是从临床转诊或广告招募而来的，在入组时符合 BP-NOS 的操作性标准，并至少参加了一次随访评估（初始队列的 91%）。在随访访谈中使用纵向间隔随访评估（Longitudinal Interval Follow-Up Evaluation）来评估诊断。平均随访时间为 5 年，评估间隔平均为 8.2 个月。
共有 63 名（45%）受试者发生了 BP-I 或 BP-II 的诊断转换：32 名（23%）转为 BP-I（其中 9 名最初转为 BP-II），31 名转为仅 BP-II（22%）。从入组到转换的中位数时间为 58 周。躁狂或轻躁狂的一级或二级家族史是预测诊断转换的最强基线因素（p =.006）。在随访期间，转换与轻躁狂症状的强度增加以及接受专门的、强化的门诊心理社会治疗的暴露增加有关。转换与特定药物类别的暴露之间没有关联。
因符合操作性 BP-NOS 诊断标准的情绪症状而被转介的儿童和青少年，特别是那些有 BP 家族史的人，常常会发展为 BP-I 或 BP-II。努力识别这些青少年并进行有效干预，可能有潜力遏制这一高风险人群中情绪障碍的进展。
