Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Clin Psychiatry. 2012 Jan;73(1):87-94. doi: 10.4088/JCP.10m06720. Epub 2011 Dec 13.
Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder, but, to our knowledge, no studies examined the course of anxiety disorders in youth and adults with bipolar disorder.
As part of the Course and Outcome of Bipolar Youth study, 413 youth, ages 7 to 17 years who met criteria for Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) bipolar I disorder (n = 244), bipolar II disorder (n = 28), and operationally defined bipolar disorder not otherwise specified (n = 141) were recruited primarily from outpatient clinics. Subjects were followed on average for 5 years using the Longitudinal Interval Follow-Up Evaluation. We examined factors associated with the persistence (> 50% of the follow-up time) and onset of new anxiety disorders in youth with bipolar disorder.
Of the 170 youth who had anxiety at intake, 80.6% had an anxiety disorder at any time during the follow-up. Most of the anxiety disorders during the follow-up were of the same type as those present at intake. About 50% of the youth had persistent anxiety, particularly generalized anxiety disorder (GAD). Persistence was associated with multiple anxiety disorders, less follow-up time in euthymia, less conduct disorder, and less treatment with antimanic and antidepressant medications (all P values ≤ .05). Twenty-five percent of the sample who did not have an anxiety disorder at intake developed new anxiety disorders during follow-up, most commonly GAD. The onset of new anxiety disorders was significantly associated with being female, lower socioeconomic status, presence of attention-deficit/hyperactivity disorder and substance use disorder, and more follow-up time with manic or hypomanic symptoms (all P values ≤ .05)
Anxiety disorders in youth with bipolar disorder tend to persist, and new-onset anxiety disorders developed in a substantial proportion of the sample. Early identification of factors associated with the persistence and onset of new anxiety disorders may enable the development of strategies for treatment and prevention.
焦虑障碍是双相障碍青少年中最常见的共病之一，但据我们所知，尚无研究探讨双相障碍青少年和成人的焦虑障碍病程。
作为双相障碍青年病程和结局研究的一部分，我们纳入了 413 名年龄在 7 至 17 岁之间、符合《精神障碍诊断与统计手册》第四版（DSM-IV）双相 I 障碍（n=244）、双相 II 障碍（n=28）和操作性定义的双相障碍未特定型（n=141）标准的患者。这些患者主要来自于门诊。使用纵向间隔随访评估（Longitudinal Interval Follow-Up Evaluation），平均随访 5 年。我们研究了与双相障碍青少年中持续性（>50%随访时间）和新发焦虑障碍相关的因素。
在入组时有焦虑症状的 170 名青少年中，80.6%在随访期间任何时候都有焦虑障碍。随访期间的大多数焦虑障碍与入组时的类型相同。约 50%的青少年有持续性焦虑，特别是广泛性焦虑障碍（GAD）。持续性与多种焦虑障碍、更多的躁狂相时间、较少的品行障碍和较少的抗躁狂和抗抑郁药物治疗有关（所有 P 值均≤.05）。在入组时没有焦虑障碍的样本中，有 25%在随访期间出现新发焦虑障碍，最常见的是 GAD。新发焦虑障碍的发生与女性、较低的社会经济地位、存在注意缺陷/多动障碍和物质使用障碍以及更多的躁狂或轻躁狂症状的随访时间有关（所有 P 值均≤.05）。
双相障碍青少年的焦虑障碍往往会持续存在，而且新出现的焦虑障碍在很大一部分样本中出现。早期识别与持续性和新发焦虑障碍相关的因素，可能有助于制定治疗和预防策略。
