Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, C/Ibiza 43, 28009, Madrid, Spain.
Department of Psychiatry and Clinical Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Eur Child Adolesc Psychiatry. 2018 Nov;27(11):1459-1471. doi: 10.1007/s00787-018-1135-y. Epub 2018 Mar 8.
Shared vulnerability in offspring of individuals with schizophrenia (SzO) and bipolar disorder (BpO) might manifest early during development through common temperament traits. Temperament dimensions in child and adolescent BpO (N = 80), SzO (N = 34) and the offspring of community controls (CcO) (N = 101) were assessed using the Revised Dimensions of Temperament Survey. The association between temperament dimensions and lifetime psychopathology (including threshold and subthreshold DSM-IV-TR diagnoses) and current socio-academic adjustment was assessed using logistic regression. Fully adjusted models showed that both BpO and SzO scored significantly lower in the positive mood dimension and in the adaptability factor than CcO, with small-medium effect sizes (Cohen's d ~ 0.3-0.5). BpO also scored lower in the activity factor and the activity dimensions than CcO (Cohen's d ~ 0.3). Lower scores in the positive mood dimension were associated with increased risk of impaired adjustment both in BpO [OR 2.30, 95% CI (1.18-4.46)] and in SzO [OR 2.87, 95% CI (1.07-7.66)]. In BpO, lower scores in positive mood were also associated with increased likelihood of internalizing [OR 1.84, 95% CI (1.28-2.64)] and externalizing disorders [OR 1.48, 95% CI (1.01-2.18)]; in SzO, higher scores in activity and flexibility were associated with increased likelihood of internalizing [OR 2.31, 95% CI (1.22-4.38)] and externalizing disorders [OR 3.28, 95% CI (1.2-9)], respectively. Early difficulties in emotion regulation might represent a shared vulnerability phenotype in BpO and SzO. The identification of extreme temperament traits could help to characterize subgroups at greater risk of psychopathology and impaired adjustment, in which targeted interventions are warranted.
精神分裂症(SzO)和双相情感障碍(BpO)患者的后代可能存在共同的脆弱性,这种脆弱性可能在发育早期通过共同的气质特征表现出来。使用修订后的气质调查评估了儿童和青少年 BpO(N=80)、SzO(N=34)和社区对照组(CcO)(N=101)的气质维度。使用逻辑回归评估气质维度与终生精神病理学(包括阈和亚阈 DSM-IV-TR 诊断)和当前社会学术适应之间的关联。完全调整后的模型显示,BpO 和 SzO 在积极情绪维度和适应性因素上的得分均明显低于 CcO,具有中等偏小的效应大小(Cohen's d0.3-0.5)。BpO 在活动因素和活动维度上的得分也低于 CcO(Cohen's d0.3)。积极情绪维度的得分较低与 BpO 中较差的适应能力风险增加相关[OR 2.30,95%CI(1.18-4.46)]和 SzO[OR 2.87,95%CI(1.07-7.66)]。在 BpO 中,积极情绪得分较低也与患内化障碍的可能性增加有关[OR 1.84,95%CI(1.28-2.64)]和外化障碍[OR 1.48,95%CI(1.01-2.18)];在 SzO 中,活动和灵活性得分较高与内化障碍的可能性增加有关[OR 2.31,95%CI(1.22-4.38)]和外化障碍[OR 3.28,95%CI(1.2-9)]。早期情绪调节困难可能是 BpO 和 SzO 共有的脆弱性表型。识别极端气质特征可以帮助确定具有更高精神病理学和适应不良风险的亚群,需要针对这些亚群进行有针对性的干预。