Juvenile Bipolar Research Foundation, Maplewood, New Jersey, USA.
Curr Opin Pediatr. 2013 Jun;25(3):419-26. doi: 10.1097/MOP.0b013e3283600e2a.
Pediatricians are increasingly confronted with the mental health needs of children. Given the unanticipated role, well-described diagnostic guidelines and treatment protocols are essential: but often lacking. Identification of bipolar disorder in children, a condition which lacks diagnostic criteria consensus, presents a particular challenge. Despite this, it is generally regarded as a condition associated with considerable morbidity and mortality. Extended delays to treatment, typical for the condition, contribute to significantly reduced adult functionality.
Most children with bipolar disorder exhibit a subsyndromal course of illness. This has prompted many investigative groups to explore whether such a presentation is developmental or unique. Despite the ongoing debate, there has been a rapid increase in the rate of diagnoses. Concurrently, breakthroughs in neurology, neuroimaging, and genetics have called into question the existing conceptually based psychiatric constructs altogether. New research approaches which reflect these advances are more likely to lead to evidence-based diagnosis and treatment. Such an example is a novel phenotype called Fear of Harm (FOH). A new research perspective resulted in the unification of a broad range of symptoms from bipolar disorder as well as many of the co-occurring disorders. When considered as a whole, the syndrome maps on to a known neural pathway and has led investigators to a putative biomarker.
If given the right information and tools, pediatricians are uniquely positioned to interrupt the decline caused by mental illnesses. Importantly, the newly defined FOH syndrome includes clinical symptoms which are frequently first brought to the attention of pediatricians. Although these symptoms are not exclusive to the mood disorder, they could alert pediatricians to the need for further evaluation.
儿科医生越来越多地面临儿童心理健康需求。鉴于预期角色，描述良好的诊断指南和治疗方案是必不可少的：但往往缺乏。儿童双相情感障碍的识别存在诊断标准共识缺失的问题，这是一个特别的挑战。尽管如此，它通常被认为是一种与相当高的发病率和死亡率相关的疾病。这种情况下，治疗的延迟通常会导致显著降低成年后的功能。
大多数患有双相情感障碍的儿童表现出亚综合征的疾病过程。这促使许多研究小组探索这种表现是发育性的还是独特的。尽管存在持续的争论，但诊断率迅速上升。与此同时，神经病学、神经影像学和遗传学的突破彻底改变了基于概念的现有精神病学结构。反映这些进展的新研究方法更有可能导致基于证据的诊断和治疗。一个新的研究视角，即所谓的伤害恐惧（Fear of Harm，FOH），就是一个很好的例子。这种新的研究视角将双相情感障碍以及许多共病的广泛症状统一起来。当作为一个整体考虑时，该综合征映射到已知的神经通路，并导致研究人员提出了一个假定的生物标志物。
如果给予正确的信息和工具，儿科医生处于独特的位置，可以阻止精神疾病导致的衰退。重要的是，新定义的 FOH 综合征包括儿科医生首先注意到的临床症状。尽管这些症状并非仅限于情绪障碍，但它们可能提醒儿科医生需要进一步评估。
