Karantanos G
Psychiatriki. 2012 Jun;23 Suppl 1:15-26.
Important data about possible continuities and discontinuities of psychopathology from childhood to adulthood have been provided by findings from well scheduled prospective longitudinal studies of community-based samples. Findings from clinical populations have contributed as well. This presentation relies on data from selected studies of reference. An effort is made to combine results demonstrating the extent of continuity at a more general level with those indicating continuities or discontinuities concerning disorders commonly presented in clinical practice. These disorders are those included in the internalizing (anxiety and mood disorders) and externalizing (ADHD, oppositional, conduct disorder-antisocial personality disorder) domains of psychopathology. Discontinuities do exist, however findings also suggest considerable longitudinal links between childhood-adolescence and adulthood. Reports from the Dunedin longitudinal study showed that half of those with psychiatric diagnoses at the age of 26 had met criteria for psychiatric disorder by the age of 15, and that figure approached 75% by the age of 18. Homotypic continuity is the most prominent. There are also heterotypic continuities, while homotypic and heterotypic continuities may co-occur. Among common disorders, findings suggest continuity tendencies even for anxiety disorders and for subclinical cases with obsessive and compulsive symptoms as well. Comorbidity between different anxiety disorders (strict homotypic continuity) as well as between them and depression (broad homotypic continuity) is very common. In the externalizing domain, longitudinal links between conduct disorder and antisocial personality disorder, including adverse consequences in psychosocial functioning, have been repeatedly found. Childhood onset subtype of conduct disorder is more prone to this adverse outcome, however all cases with conduct disorder need early recognition and intervention. During the course of conduct disorder, substance use is now recognized as a kind of homotypic continuity. About half of attention deficit-hyperactivity disorder (ADHD) cases continue into adulthood. These individuals usually face problems in several aspects of their adult life, such as interpersonal relationships, educational and occupational functioning. In ADHD cases, the emergence of conduct disorder worsens the adverse outcome; therefore prevention of this complication is of significant importance for intervention. There are indications that oppositional disorder cases may be heterogeneous and that this may explain the heterotypic continuities that have been found so far. Many aspects are open to further study, particularly those concerning the possible mechanisms involved in continuities or discontinuities in various disorders. Data suggesting the extent of continuities are important for both child psychiatry and psychiatry. Attention should be focused on early intervention, services provision and cooperation. The latter is of vital importance during the transition from child to adult services.
基于社区样本的精心安排的前瞻性纵向研究结果，提供了有关精神病理学从童年到成年可能的连续性和不连续性的重要数据。临床人群的研究结果也有贡献。本报告依赖于所选参考文献研究的数据。我们努力将在更一般水平上证明连续性程度的结果与那些表明临床实践中常见疾病的连续性或不连续性的结果结合起来。这些疾病包括内化性（焦虑和情绪障碍）和外化性（注意力缺陷多动障碍、对立违抗障碍、品行障碍 - 反社会人格障碍）精神病理学领域的疾病。然而，不连续性确实存在，但研究结果也表明童年 - 青少年期和成年期之间存在相当多的纵向联系。达尼丁纵向研究的报告显示，26岁时患有精神疾病诊断的人中有一半在15岁时就符合精神疾病标准，到18岁时这一数字接近75%。同型连续性最为突出。也存在异型连续性，而同型和异型连续性可能同时出现。在常见疾病中，研究结果表明即使是焦虑症以及有强迫症状的亚临床病例也存在连续性倾向。不同焦虑症之间（严格的同型连续性）以及它们与抑郁症之间（广泛的同型连续性）的共病非常常见。在外化性领域，品行障碍与反社会人格障碍之间的纵向联系，包括心理社会功能方面的不良后果，已被反复发现。品行障碍的儿童期起病亚型更容易出现这种不良后果，然而所有品行障碍病例都需要早期识别和干预。在品行障碍的过程中，物质使用现在被认为是一种同型连续性。大约一半的注意力缺陷多动障碍（ADHD）病例会持续到成年。这些个体在成年生活的几个方面通常会面临问题，如人际关系、教育和职业功能。在ADHD病例中，品行障碍的出现会使不良后果恶化；因此预防这种并发症对干预至关重要。有迹象表明对立违抗障碍病例可能是异质性的，这可能解释了迄今为止发现的异型连续性。许多方面有待进一步研究，特别是那些涉及各种疾病连续性或不连续性的可能机制的方面。表明连续性程度的数据对儿童精神病学和精神病学都很重要。应将注意力集中在早期干预、服务提供和合作上。后者在从儿童服务向成人服务的过渡过程中至关重要。
