Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, 9000 Rockville Pike, Building 10, Room 1-3616, Bethesda, MD, 20892-1281, USA.
J Am Acad Child Adolesc Psychiatry. 2013 May;52(5):466-81. doi: 10.1016/j.jaac.2013.02.006. Epub 2013 Apr 4.
Bipolar disorder-not otherwise specified (BP-NOS) and severe mood dysregulation (SMD) are severe mood disorders that were defined to address questions about the diagnosis of bipolar disorder (BD) in youth. SMD and BP-NOS are distinct phenotypes that differ in clinical presentation and longitudinal course. The purpose of this review is to inform clinicians about the clinical features of the two phenotypes and about the research literature distinguishing them.
A literature review was performed on SMD as studied in the National Institute of Mental Health Intramural Research Program and on BP-NOS in youth. For BP-NOS, the phenotype defined in the Course of Bipolar Youth study is the focus, because this has received the most study.
SMD is characterized by impairing, chronic irritability without distinct manic episodes. Most commonly, BP-NOS is characterized by manic, mixed, or hypomanic episodes that are too short to meet the DSM-IV-TR duration criterion. Research provides strong, albeit suggestive, evidence that SMD is not a form of BD; the most convincing evidence are longitudinal data indicating that youth with SMD are not at high risk to develop BD as they age. The BP-NOS phenotype appears to be on a diagnostic continuum with BD types I and II. Subjects with BP-NOS and those with BD type I have similar symptom and family history profiles, and youth with BP-NOS are at high risk to develop BD as they age. Currently, little research guides treatment for either phenotype.
Pressing research needs include identifying effective treatments for these phenotypes, ascertaining biomarkers that predict conversion from BP-NOS to BD, elucidating associations between SMD and other disorders, and defining the neural circuitry mediating each condition.
双相情感障碍未特定型（BP-NOS）和严重情绪失调（SMD）是两种严重的情绪障碍，它们的定义旨在解决青少年双相情感障碍（BD）诊断中的问题。SMD 和 BP-NOS 是两种不同的表型，在临床表现和纵向病程上有所不同。本综述的目的是向临床医生介绍这两种表型的临床特征以及区分它们的研究文献。
对国家心理健康研究所内部研究计划中研究的 SMD 以及青少年 BP-NOS 进行文献回顾。对于 BP-NOS，研究的重点是在《双相青少年研究》中定义的表型，因为该研究受到了最多的关注。
SMD 的特征是表现为慢性、致残性的易激惹，而没有明显的躁狂发作。BP-NOS 最常见的特征是躁狂、混合或轻躁狂发作，但发作时间太短，不符合 DSM-IV-TR 持续时间标准。研究提供了强有力的、尽管只是提示性的证据，表明 SMD 不是 BD 的一种形式；最有说服力的证据是纵向数据表明，随着年龄的增长，患有 SMD 的青少年患 BD 的风险并不高。BP-NOS 表型似乎与 BD 一型和二型处于诊断连续体上。患有 BP-NOS 的患者和患有 BD 一型的患者具有相似的症状和家族史特征，而且随着年龄的增长，患有 BP-NOS 的青少年患 BD 的风险很高。目前，针对这两种表型的治疗方法的研究很少。
迫切需要开展研究的领域包括确定针对这些表型的有效治疗方法、确定预测从 BP-NOS 向 BD 转变的生物标志物、阐明 SMD 与其他疾病之间的关联以及定义介导每种疾病的神经回路。
