Nurnberger John I, McInnis Melvin, Reich Wendy, Kastelic Elizabeth, Wilcox Holly C, Glowinski Anne, Mitchell Philip, Fisher Carrie, Erpe Mariano, Gershon Elliot S, Berrettini Wade, Laite Gina, Schweitzer Robert, Rhoadarmer Kelly, Coleman Vegas V, Cai Xueya, Azzouz Faouzi, Liu Hai, Kamali Masoud, Brucksch Christine, Monahan Patrick O
Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, 46202-4887, USA.
Arch Gen Psychiatry. 2011 Oct;68(10):1012-20. doi: 10.1001/archgenpsychiatry.2011.126.
The childhood precursors of adult bipolar disorder (BP) are still a matter of controversy.
To report the lifetime prevalence and early clinical predictors of psychiatric disorders in offspring from families of probands with DSM-IV BP compared with offspring of control subjects.
A longitudinal, prospective study of individuals at risk for BP and related disorders. We report initial (cross-sectional and retrospective) diagnostic and clinical characteristics following best-estimate procedures.
Assessment was performed at 4 university medical centers in the United States between June 1, 2006, and September 30, 2009.
Offspring aged 12 to 21 years in families with a proband with BP (n = 141, designated as cases) and similarly aged offspring of control parents (n = 91).
Lifetime DSM-IV diagnosis of a major affective disorder (BP type I; schizoaffective disorder, bipolar type; BP type II; or major depression).
At a mean age of 17 years, cases showed a 23.4% lifetime prevalence of major affective disorders compared with 4.4% in controls (P = .002, adjusting for age, sex, ethnicity, and correlation between siblings). The prevalence of BP in cases was 8.5% vs 0% in controls (adjusted P = .007). No significant difference was seen in the prevalence of other affective, anxiety, disruptive behavior, or substance use disorders. Among case subjects manifesting major affective disorders (n = 33), there was an increased risk of anxiety and externalizing disorders compared with cases without mood disorder. In cases but not controls, a childhood diagnosis of an anxiety disorder (relative risk = 2.6; 95% CI, 1.1-6.3; P = .04) or an externalizing disorder (3.6; 1.4-9.0; P = .007) was predictive of later onset of major affective disorders.
Childhood anxiety and externalizing diagnoses predict major affective illness in adolescent offspring in families with probands with BP.
成人双相情感障碍（BP）在儿童期的先兆仍存在争议。
报告与对照受试者的后代相比，先证者患有DSM-IV双相情感障碍的家庭中后代精神障碍的终生患病率和早期临床预测因素。
一项针对双相情感障碍及相关疾病风险个体的纵向、前瞻性研究。我们按照最佳估计程序报告初始（横断面和回顾性）诊断及临床特征。
2006年6月1日至2009年9月30日期间在美国4所大学医学中心进行评估。
患有双相情感障碍先证者家庭中12至21岁的后代（n = 141，指定为病例组）以及对照父母的同龄后代（n = 91）。
终生DSM-IV诊断的主要情感障碍（I型双相情感障碍；精神分裂情感障碍，双相型；II型双相情感障碍；或重度抑郁症）。
在平均年龄17岁时，病例组主要情感障碍的终生患病率为23.4%，而对照组为4.4%（P = 0.002，校正年龄、性别、种族及同胞间相关性后）。病例组双相情感障碍的患病率为8.5%，对照组为0%（校正后P = 0.007）。在其他情感、焦虑、破坏性行为或物质使用障碍的患病率方面未观察到显著差异。在表现出主要情感障碍的病例组受试者（n = 33）中，与无情绪障碍的病例相比，焦虑和外化障碍的风险增加。在病例组而非对照组中，儿童期诊断为焦虑障碍（相对风险 = 2.6；95%CI，1.1 - 6.3；P = 0.04）或外化障碍（3.6；1.4 - 9.0；P = 0.007）可预测后期主要情感障碍的发病。
儿童期焦虑和外化障碍诊断可预测双相情感障碍先证者家庭中青少年后代的主要情感疾病。
