Department of Psychiatry and Human Behavior, Emma Pendleton Bradley Hospital, Providence, RI, USA.
J Clin Psychiatry. 2013 Jan;74(1):e110-7. doi: 10.4088/JCP.12m07874.
To assess whether relative severity of irritability symptoms versus elation symptoms in mania is stable and predicts subsequent illness course in youth with DSM-IV bipolar I or II disorder or operationally defined bipolar disorder not otherwise specified.
Investigators used the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children to assess the most severe lifetime manic episode in bipolar youth aged 7-17 years who were recruited from 2000 to 2006 as part of the Course and Outcomes of Bipolar Youth prospective cohort study (N = 361), conducted at university-affiliated mental health clinics. Subjects with at least 4 years of follow-up (N = 309) were categorized as irritable-only (n = 30), elated-only (n = 42), or both irritable and elated (n = 237) at baseline. Stability of this categorization over follow-up was the primary outcome. The course of mood symptoms and episodes, risk of suicide attempt, and functioning over follow-up were also compared between baseline groups.
Most subjects experienced both irritability and elation during follow-up, and agreement between baseline and follow-up group assignment did not exceed that expected by chance (κ = 0.03; 95% CI, -0.06 to 0.12). Elated-only subjects were most likely to report the absence of both irritability and elation symptoms at every follow-up assessment (35.7%, versus 26.7% of irritable-only subjects and 16.9% of those with both irritability and elation; P = .01). Baseline groups experienced mania or hypomania for a similar proportion of the follow-up period, but irritable-only subjects experienced depression for a greater proportion of the follow-up period than did subjects who were both irritable and elated (53.9% versus 39.7%, respectively; P = .01). The groups did not otherwise differ by course of mood episode duration, polarity, bipolar diagnostic type, suicide attempt risk, or functional impairment.
Most bipolar youth eventually experienced both irritability and elation irrespective of history. Irritable-only youth were at similar risk for mania but at greater risk for depression compared with elated-only youth and youth who had both irritability and elation symptoms.
评估在 DSM-IV 双相情感障碍 I 型或 II 型或操作性定义的特定未指明双相情感障碍患者中，躁狂症的易激惹症状与欣快症状的相对严重程度是否稳定，并预测随后的疾病过程。
研究人员使用儿童心境障碍和精神分裂症量表（Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children）评估 2000 年至 2006 年期间招募的 7-17 岁双相情感障碍青少年一生中最严重的躁狂发作，这些青少年是作为前瞻性队列研究（Course and Outcomes of Bipolar Youth）的一部分参加的，该研究在大学附属心理健康诊所进行（N=361）。至少有 4 年随访的受试者（N=309）被归类为基线时仅易激惹（n=30）、仅欣快（n=42）或易激惹和欣快两者（n=237）。这种分类在随访中的稳定性是主要结果。还比较了基线组之间随访期间的情绪症状和发作、自杀企图风险以及功能。
大多数受试者在随访期间都经历了易激惹和欣快，基线和随访组分配之间的一致性不超过预期的机会水平（κ=0.03；95%CI，-0.06 至 0.12）。仅欣快的受试者最有可能在每次随访评估时报告既没有易激惹也没有欣快症状（35.7%，而仅易激惹的受试者为 26.7%，两者均有易激惹和欣快的受试者为 16.9%；P=0.01）。基线组在随访期间经历躁狂或轻躁狂的比例相似，但仅易激惹的受试者在随访期间经历抑郁的比例高于既易激惹又欣快的受试者（分别为 53.9%和 39.7%；P=0.01）。各组在躁狂症或轻躁狂发作的持续时间、极性、双相诊断类型、自杀企图风险或功能障碍方面没有其他差异。
大多数双相情感障碍患者最终都会经历易激惹和欣快，无论是否有病史。仅易激惹的青少年患躁狂症的风险相似，但患抑郁症的风险高于仅欣快的青少年和既有易激惹又有欣快症状的青少年。
