Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA; Butler Hospital, 700 Butler Drive, Providence, RI 02906, USA.
J Affect Disord. 2019 Mar 1;246:578-585. doi: 10.1016/j.jad.2018.12.108. Epub 2018 Dec 26.
In a sample of participants diagnosed with Bipolar Disorder (BD) in youth, we aim: (1) to examine longitudinal psychosocial functioning; (2) to determine whether psychosocial impairment remains in those who remitted from mood disorders during later periods of follow-up; (3) to examine predictors of psychosocial impairment despite symptomatic remission.
A Course and Outcome of Bipolar Youth subsample of 367 (≥ 4 years follow-up data) were grouped into mood trajectories: Class 1 Predominantly Euthymic; Class 2 Moderately Euthymic; Class 3 Ill with Improving Course; Class 4 Predominantly Ill. Psychosocial functioning was assessed via Children's Global Assessment Scale (C-GAS) for those under age 22; Global Assessment of Functioning (GAF) scale after 22. Current school, employment, and disability status were examined. Established predictors of symptomatic impairment were analyzed.
The Predominantly Euthymic Class had better psychosocial functioning, and were more likely to be in school/employed. The Persistently Ill Class had worse psychosocial functioning, and were more likely to receive disability. However, 44% of Predominantly Euthymic and 93% of Ill with Improving Course participants continued to experience current psychosocial impairment. Early BD onset, low Socioeconomic Status (SES), and current comorbidity, predicted poor psychosocial functioning. Low SES, and current comorbidity, predicted no school enrollment/unemployment.
The study does not have a healthy control group to compare functioning findings.
In general, youth with persistent mood symptoms had worse psychosocial functioning, moreover, those with remitted symptoms still exhibited current psychosocial functioning deficits. High risk individuals with predictors of impairment should be targeted for functioning interventions.
在一组被诊断为青少年双相情感障碍（BD）的参与者样本中，我们旨在：（1）检查纵向心理社会功能；（2）确定在随后的随访期间情绪障碍缓解的人中，心理社会损害是否仍然存在；（3）检查尽管症状缓解但仍存在心理社会损害的预测因素。
一项青少年双相情感障碍的病程和结局子样本，共 367 人（≥4 年随访数据），分为以下情绪轨迹：第 1 类以情绪良好为主；第 2 类情绪中度良好；第 3 类病情改善但仍不稳定；第 4 类病情主要不稳定。对年龄在 22 岁以下的儿童采用儿童总体评估量表（C-GAS）评估心理社会功能；对 22 岁以上的儿童采用总体功能评估量表（GAF）评估。研究了当前的学校、就业和残疾状况。分析了症状性损害的既定预测因素。
以情绪良好为主的第 1 类具有更好的心理社会功能，更有可能在学校/就业。持续不稳定的第 4 类情绪功能更差，更有可能获得残疾。然而，44%的情绪良好为主的参与者和 93%的病情改善但仍不稳定的参与者仍经历着当前的心理社会损害。BD 发病早、社会经济地位低（SES）和当前合并症与较差的心理社会功能相关。SES 低和当前合并症与无学校入学/失业相关。
该研究没有健康对照组来比较功能发现。
一般来说，有持续情绪症状的青少年心理社会功能较差，此外，有缓解症状的个体仍表现出当前的心理社会功能缺陷。具有受损预测因素的高危个体应作为功能干预的目标。
