Hernandez Mariely, Marangoni Ciro, Grant Marie C, Estrada Jezelle, Faedda Gianni L
Lucio Bini Mood Disorders Center, 245 East 50th Street, Suite 2A, New York, NY, 10022-7752, USA.
Centro Lucio Bini, Rome, Italy.
Curr Neuropharmacol. 2017 Apr;15(3):380-385. doi: 10.2174/1570159X14666160801162046.
Early psychopathology in children diagnosed with Bipolar Disorder (BD) remains poorly characterized. Parental retrospective reports provide helpful details on the earliest manifestations and their evolution over time. These symptoms occur early in the course of BD, often before a formal diagnosis is made and/or treatment is implemented, and are of great importance to early recognition and prevention.
Parents of pre-pubertal children and adolescents with DSM-IV diagnoses of BD attending an outpatient mood disorders clinic provided retrospective ratings of 37 symptoms of child psychopathology. Stability and comorbidity of diagnoses were evaluated, and severity of symptoms for each subject was assessed by identifying the earliest occurrence of the reported symptoms causing impairment.
Severe mood instability, temper tantrums, anxiety symptoms, sleep disturbances and aggression were among the most common signs of psychopathology reported in children diagnosed with BD before puberty. Symptoms were already apparent in the first three years in 28%, and formal diagnoses were made before the age of 8 y in the majority of cases.
Retrospective parental reports of early symptoms of psychopathology in pre-pubertal children with BD revealed a very early occurrence of affective precursors (irritability and mood dysregulation) and clinical risk factors like impulsive aggression and anxiety that can precede the syndromal onset of mania by several years. These findings support previous reports suggesting a progression of symptoms from abnormal, non-specific presentations to sub-threshold and finally syndromal BD. The importance of early identification and intervention is discussed.
被诊断为双相情感障碍（BD）的儿童的早期精神病理学特征仍不明确。父母的回顾性报告提供了有关最早表现及其随时间演变的有用细节。这些症状在双相情感障碍病程早期出现，通常在正式诊断和/或实施治疗之前，对早期识别和预防非常重要。
在门诊情绪障碍诊所就诊的、符合DSM-IV双相情感障碍诊断标准的青春期前儿童和青少年的父母，对37种儿童精神病理学症状进行回顾性评分。评估诊断的稳定性和共病情况，并通过确定报告的导致损害的症状最早出现情况来评估每个受试者的症状严重程度。
严重情绪不稳定、发脾气、焦虑症状、睡眠障碍和攻击性是青春期前被诊断为双相情感障碍的儿童中最常见的精神病理学症状。28%的症状在头三年就已明显，大多数病例在8岁前做出正式诊断。
父母对青春期前双相情感障碍儿童精神病理学早期症状的回顾性报告显示，情感前驱症状（易怒和情绪失调）以及冲动攻击性和焦虑等临床风险因素在躁狂综合征发作前数年就已很早出现。这些发现支持了先前的报告，即症状从异常、非特异性表现发展为亚阈值症状，最终发展为综合征性双相情感障碍。文中讨论了早期识别和干预的重要性。
