Hirneth Stephen J, Hazell Philip L, Hanstock Tanya L, Lewin Terry J
Hunter New England Local Health District, Child and Adolescent Mental Health Service, Newcastle, NSW, Australia; University of Sydney, Sydney Medical School, Discipline of Psychiatry, Sydney, NSW, Australia.
University of Sydney, Sydney Medical School, Discipline of Psychiatry, Sydney, NSW, Australia; Sydney and South Western Sydney Local Health Districts, Infant Child and Adolescent Mental Health Services, Sydney, NSW, Australia.
J Affect Disord. 2015 Apr 1;175:98-107. doi: 10.1016/j.jad.2014.12.021. Epub 2014 Dec 13.
Bipolar disorder (BD) phenomenology in children and adolescents remains contentious. The study investigated Australian children and adolescents with bipolar I disorder (BD-I), bipolar II disorder (BD-II), or BD not otherwise specified (BD-NOS).
Index episode demographics, symptomatology, functioning and diagnostic data were compared for 88 participants (63 female) aged 8-18 years (M=14.8, SD=2.5) meeting DSM-IV-TR criteria for BD-I (n=24), BD-II (n=13) or BD-NOS (n=51).
BD-I had higher rates of previous episodes, psychotropic medication (compared to BD-II but not BD-NOS), rates of inpatient admissions (compared to BD-NOS), and number of inpatient admissions (compared to BD-II). BD-II had lower rates of lifetime depression and anxiety disorders, higher frequency of hypomania, shorter duration of illness, and fewer previous episodes. BD-NOS had younger age of onset, chronic course, irritability and mixed presentation. All BD subtypes had high rates of self-harm (69.3%), suicidal ideation (73.9%), suicide attempts (36.4%), psychiatric admission (55.7%), and psychosis (36.4%).
There were relatively small numbers of BD-I and BD-II. Diagnoses were based on retrospective recall.
All BD subtypes had high levels of acuity and clinical risk. In accord with previous results, BD-I and BD-II participants' phenomenology was consistent with classical descriptions of these subtypes. BD-NOS participants were younger, with less euphoric mania but otherwise phenomenologically on a continuum with BD-I, suggesting that child and adolescent BD-NOS may be an early and less differentiated phase of illness of BD-I or BD-II and hence a target for early intervention.
儿童和青少年双相情感障碍（BD）的临床表现仍存在争议。本研究对患有I型双相情感障碍（BD-I）、II型双相情感障碍（BD-II）或未特定型双相情感障碍（BD-NOS）的澳大利亚儿童和青少年进行了调查。
比较了88名年龄在8至18岁（M = 14.8，SD = 2.5）的参与者（63名女性）的首发发作人口统计学、症状学、功能和诊断数据，这些参与者符合DSM-IV-TR标准的BD-I（n = 24）、BD-II（n = 13）或BD-NOS（n = 51）。
BD-I既往发作率更高，使用精神药物的比例更高（与BD-II相比，但与BD-NOS相比无差异），住院率更高（与BD-NOS相比），住院次数更多（与BD-II相比）。BD-II终生抑郁和焦虑障碍的发生率较低，轻躁狂发作频率较高，病程较短，既往发作次数较少。BD-NOS起病年龄较小，病程慢性，易激惹，表现为混合症状。所有BD亚型的自我伤害率（69.3%）、自杀观念率（73.9%）、自杀未遂率（36.4%）、精神科住院率（55.7%）和精神病发生率（36.4%）都很高。
BD-I和BD-II的样本数量相对较少。诊断基于回顾性回忆。
所有BD亚型的严重程度和临床风险都很高。与先前结果一致，BD-I和BD-II参与者的临床表现与这些亚型的经典描述相符。BD-NOS参与者年龄较小，躁狂发作时的欣快感较少，但在现象学上与BD-I处于连续体，这表明儿童和青少年BD-NOS可能是BD-I或BD-II疾病的早期且分化程度较低的阶段，因此是早期干预的目标。
