Arango Celso, Fraguas David, Parellada Mara
*To whom correspondence should be addressed; Hospital General Universitario Gregorio Marañón, Ibiza 43, 28009 Madrid, Spain; tel: 34-914265006; fax: 34-91426004, e-mail:
Schizophr Bull. 2014 Mar;40 Suppl 2(Suppl 2):S138-46. doi: 10.1093/schbul/sbt198. Epub 2013 Dec 26.
Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders.
精神分裂症和双相情感障碍不仅有共同的临床特征，还存在一些共同的风险因素，如基因标记和童年逆境，而其他风险因素，如城市化和产科并发症，似乎是精神分裂症所特有的。一个有趣的问题是，许多最终发展为精神分裂症的儿童和青少年中已被充分证实的异常神经发育在双相情感障碍患者中是否也存在。关于成年双相情感障碍患者的文献存在争议。我们报告了一组儿童期起病的精神病性双相情感障碍患者的数据，这些患者似乎与早发性精神分裂症患者有一些共同的发育轨迹。这些早发性精神病性双相情感障碍患者智商较低，有更多的神经学体征，首次精神病发作时额叶灰质减少，与健康对照组相比，大脑变化更大，其模式与早发性精神分裂症病例相似。然而，早发性精神分裂症患者在童年期似乎比早发性双相情感障碍患者有更多的社会功能损害、发育异常（如语言问题）和更低学业成绩。我们认为，这些异常发育轨迹中的一些与这两种综合征的表型特征（如早发性精神病性症状）的关系比与《精神疾病诊断与统计手册》明确界定的疾病类别更为密切。
