Frías Álvaro, Palma Cárol, Farriols Núria
FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain.
FPCEE Blanquerna, University of Ramon-Llull, Císterst 34, 08022 Barcelona, Spain; Adult Outpatient Mental Health Center, Hospital of Mataró, Mataró, Spain.
J Affect Disord. 2015 Mar 15;174:378-89. doi: 10.1016/j.jad.2014.12.008. Epub 2014 Dec 12.
Research on pediatric bipolar disorder (PBD) is providing a plethora of empirical findings regarding its comorbidity. We addressed this question through a systematic review concerning the prevalence, clinical impact, etiology and treatment of main comorbid disorders involved.
A comprehensive database search was performed from 1990 to August 2014. Overall, 167 studies fulfilled the inclusion criteria.
Bipolar youth tend to suffer from comorbid disorders, with highest weighted mean prevalence rate arising from anxiety disorders (54%), followed by attention deficit hyperactivity disorder (ADHD) (48%), disruptive behavior disorders (31%), and substance use disorders (SUD) (31%). Furthermore, evidence indicates that ADHD and anxiety disorders negatively affect the symptomatology, neurocognitive profile, clinical course and the global functioning of PBD. Likewise, several theories have been posited to explain comorbidity rates in PBD, specifically common risk factors, one disorder being a risk factor for the other and nosological artefacts. Lastly, randomized controlled trials highlight a stronger therapeutic response to stimulants and atomoxetine (vs. placebo) as adjunctive interventions for comorbid ADHD symptoms. In addition, research focused on the treatment of other comorbid disorders postulates some benefits from mood stabilizers and/or SGA.
Epidemiologic follow-up studies are needed to avoid the risk of nosological artefacts. Likewise, more research is needed on pervasive developmental disorders and anxiety disorders, especially regarding their etiology and treatment.
Psychiatric comorbidity is highly prevalent and is associated with a deleterious clinical effect on pediatric bipolarity. Different etiological pathways may explain the presence of these comorbid disorders among bipolar youth. Standardized treatments are providing ongoing data regarding their effectiveness for these comorbidities among bipolar youth.
关于儿童双相情感障碍（PBD）的研究提供了大量有关其共病情况的实证研究结果。我们通过对所涉及的主要共病障碍的患病率、临床影响、病因和治疗进行系统综述来探讨这个问题。
对1990年至2014年8月期间进行了全面的数据库检索。总体而言，167项研究符合纳入标准。
双相情感障碍青少年往往患有共病障碍，加权平均患病率最高的是焦虑症（54%），其次是注意力缺陷多动障碍（ADHD）（48%）、破坏性行为障碍（31%）和物质使用障碍（SUD）（31%）。此外，有证据表明ADHD和焦虑症会对PBD的症状、神经认知特征、临床病程和整体功能产生负面影响。同样，人们提出了几种理论来解释PBD中的共病率，特别是共同危险因素、一种障碍是另一种障碍的危险因素以及疾病分类假象。最后，随机对照试验强调，作为共病ADHD症状的辅助干预措施，兴奋剂和托莫西汀（与安慰剂相比）有更强的治疗反应。此外，针对其他共病障碍治疗的研究假定心境稳定剂和/或第二代抗精神病药物有一些益处。
需要进行流行病学随访研究以避免疾病分类假象的风险。同样，对于广泛性发育障碍和焦虑症需要更多研究，特别是关于它们的病因和治疗。
精神科共病非常普遍，并且与儿童双相情感障碍的有害临床影响相关。不同的病因途径可能解释双相情感障碍青少年中这些共病障碍的存在。标准化治疗正在提供关于其对双相情感障碍青少年这些共病有效性的持续数据。
