Department of Psychiatry, Case Western Reserve University, University Hospitals of Cleveland, OH, United States.
J Affect Disord. 2013 May;147(1-3):295-303. doi: 10.1016/j.jad.2012.11.021. Epub 2012 Dec 6.
The primary purpose of this study was to explore whether age differences in the phenomenology of bipolar disorders from 4 to 17 years of age exist.
Outcome measures included questionnaires pertaining to mood symptoms, psychosocial functioning, and family history of psychiatric illness. Phenomenology was examined in two diagnostic groups: syndromal bipolar disorder (bipolar I or II) and subsyndromal bipolar disorder (bipolar disorder not otherwise specified or cyclothymia) and across six age cohorts: 4-6, 7-8, 9-10, 11-13, and 14-17 years. Analyses examined linear and non-linear age effects on clinician-rated measures of mood and psychosocial functioning.
Participants were 535 outpatients (339 males) ages 4-17 years. The proportion diagnosed with comorbid ADHD was significantly lower in the oldest age group. Age groups showed significant moderate decreases in motor activity, aggression, and irritability with age. Many symptoms of depression showed significant increases with age. BP I cases showed much higher manic symptoms, and BP I and BP II cases indicated slightly to moderately higher depressive symptoms, compared to subsyndromal cases. These patterns held after adjusting for comorbid ADHD, and age did not interact with syndrome status. There were also age differences in total scores for measures of mood symptoms and psychosocial functioning.
Mood ratings were completed based on the same interview that informed the research diagnoses. Also, mood episode at time of interview was not captured.
These findings affirm the existence of bipolar disorder from pre-school children through adolescence, with a similar clinical presentation across a wide developmental age span.
本研究的主要目的是探讨从 4 岁到 17 岁的双相情感障碍患者的现象学是否存在年龄差异。
研究结果包括与心境症状、心理社会功能和精神疾病家族史相关的问卷。现象学在两个诊断组中进行了检查：综合征性双相情感障碍（双相 I 型或 II 型）和亚综合征性双相情感障碍（未指定的双相情感障碍或环性心境障碍），以及六个年龄组：4-6 岁、7-8 岁、9-10 岁、11-13 岁和 14-17 岁。分析检查了心境和心理社会功能的临床评定量表上的线性和非线性年龄效应。
研究对象为 535 名 4-17 岁的门诊患者（339 名男性）。在年龄最大的组中，共病 ADHD 的比例明显较低。随着年龄的增长，各组的运动活动、攻击性和易怒性显著下降。许多抑郁症状随着年龄的增长而显著增加。与亚综合征病例相比，BP I 病例的躁狂症状明显更高，BP I 和 BP II 病例的抑郁症状略高至中度升高。在调整共病 ADHD 后，这些模式仍然存在，并且年龄与综合征状态之间没有相互作用。心境症状和心理社会功能的测量总分也存在年龄差异。
心境评定是根据相同的访谈完成的，该访谈为研究诊断提供了信息。此外，访谈时的心境发作并未被捕捉到。
这些发现证实了从学前儿童到青少年期存在双相情感障碍，在广泛的发育年龄范围内具有相似的临床表现。
