Postdoctoral Fellow, Child and Adolescent Mental Health Centre-Mental Health Services Capital Region,Copenhagen Region,Psychosis Research Unit,Aarhus University HospitalandThe Lundbeck Foundation Initiative for Integrative Psychiatric Research,iPSYCH,Denmark.
Assistant Professor,Department of Psychiatry,Dalhousie University and Nova Scotia Health Authority,Canada.
Br J Psychiatry. 2018 Sep;213(3):555-560. doi: 10.1192/bjp.2018.111. Epub 2018 Jun 21.
Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder.
We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models.
Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety.
Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.
注意力缺陷多动障碍（ADHD）和焦虑症被认为是双相障碍的前驱症，但它们在双相障碍发展中的共同和相对作用尚不清楚。
测试 ADHD 和焦虑症与双相障碍发病的前瞻性关系。
我们在丹麦 1955 年至 1991 年间出生的 2409236 名队列人群中研究了 ADHD、焦虑症与双相障碍之间的关系。从 16 岁生日或从 1995 年 1 月起对个体进行随访，直至他们首次因双相障碍或直至 2012 年 12 月发生临床联系。我们计算了每 10000 人年的发病率，并在生存模型中检验了先前诊断对双相障碍风险的影响。
在超过 37394865 人年的随访中，发生了 9250 例双相障碍发病。无 ADHD 或焦虑症既往诊断的个体中双相障碍的发病率为 2.17（95%CI 2.12-2.19），仅有 ADHD 既往诊断的个体为 23.86（95%CI 19.98-27.75），仅有焦虑症既往诊断的个体为 26.05（95%CI 24.47-27.62），而 ADHD 和焦虑症均有既往诊断的个体为 66.16（95%CI 44.83-87.47）。ADHD 和焦虑症的组合使双相障碍的风险增加了 30 倍（95%CI 21.66-41.40），与无 ADHD 或焦虑症的个体相比。
内化和外化精神病理学的早期表现表明易患双相障碍。ADHD 和焦虑症的组合与双相障碍的极高风险相关。
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