Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA.
Neurosci Biobehav Rev. 2017 Mar;74(Pt A):204-213. doi: 10.1016/j.neubiorev.2017.01.022. Epub 2017 Jan 21.
Evidence of a high or increasing incidence of childhood onset bipolar disorder in the United States (US) has been viewed skeptically. Here we review evidence that childhood onsets of bipolar disorder are more common in the US than in Europe, treatment delays are longer, and illness course is more adverse and difficult. Epidemiological data and studies of offspring at high risk also support these findings. In our cohort of outpatients with bipolar disorder, two of the major vulnerability factors for early onset - genetics and environmental adversity in childhood - were also greater in the US than in Europe. An increased familial loading for multiple psychiatric disorders was apparent in 4 generations of the family members of the patients from the US, and that familial burden was linked to early onset bipolar disorder. Since both early onset and treatment delay are risk factors for a poor outcome in adulthood, new clinical, research, and public health initiatives are needed to begin to address and ameliorate this ongoing and potentially devastating clinical situation.
美国（US）儿童期起病双相障碍发病率增高的证据一直受到质疑。在这里，我们回顾了一些证据，表明与欧洲相比，美国儿童期起病的双相障碍更为常见，治疗延迟时间更长，病程更差且更难治疗。流行病学数据和高危后代的研究也支持这些发现。在我们的双相障碍门诊患者队列中，早发的两个主要脆弱性因素 - 遗传和儿童期的环境逆境 - 在美国也比在欧洲更为常见。来自美国患者的 4 代家庭成员中，多种精神障碍的家族性负荷明显增加，而这种家族负担与早发性双相障碍有关。由于早发和治疗延迟都是成年后预后不良的危险因素，因此需要新的临床、研究和公共卫生措施来开始解决和改善这种持续存在的、潜在的破坏性临床状况。
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