Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA.
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of 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, School of Medicine, University of California at San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA.
J Affect Disord. 2020 May 1;268:109-117. doi: 10.1016/j.jad.2020.03.016. Epub 2020 Mar 5.
Few studies have examined domain-specific psychosocial functioning in Bipolar Disorder (BD) youths. This prospective study examines (1) Interpersonal Relationships with Family; (2) Interpersonal Relationships with Friends; (3) School/Work; (4) Recreation; (5) Life Satisfaction, in BD youths.
A Course and Outcome of Bipolar Youth subsample (n = 367; mean intake age = 12.6 years, SD = 3.3; 46.6% female) was previously grouped into 4 Classes based on their illness trajectories and percentage of time euthymic using Latent Class Growth Analysis: Class 1 Predominantly Euthymic; Class 2 Moderately Euthymic; Class 3 Ill with Improving Course; Class 4 Predominantly Ill. Psychosocial functioning within the domains were examined for greater than 10 years using the Adolescent Longitudinal Interval Follow-Up Evaluation.
Class 1 demonstrated better functioning across all domains; Class 4 demonstrated worse functioning across all domains. Class 2 showed worsening relationships and recreation, and improvement in work/schoolwork. Class 3 showed variable domain declines and improvements. Despite symptomatic remission, 13%-20% of Class 1 and 20-47% of Classes 1/3 still had impairments across different domains. Early age of BD onset impacted impairment across most domains, and low SES significantly predicted impairment in family relationships.
The study does not have a healthy control group to compare functioning findings.
Participants with more symptomatic mood trajectories had greater impairment across domains. Moreover, even with symptomatic remission, participants still exhibited impairment. Each Class and domain had different trajectories for impairment. Results suggest the importance of examining specific (vs. global) domains for targeted treatment, even when symptomatically remitted.
很少有研究检查双相情感障碍（BD）青少年的特定领域心理社会功能。本前瞻性研究检查了（1）与家庭的人际关系；（2）与朋友的人际关系；（3）学校/工作；（4）娱乐；（5）在 BD 青少年中的生活满意度。
以前根据疾病轨迹和心境稳定百分比使用潜在类别增长分析将双相情感障碍青年子样本（n=367；平均摄入年龄为 12.6 岁，标准差为 3.3；46.6%为女性）分为 4 类：1 类主要为心境稳定；2 类为中度心境稳定；3 类为改善病程；4 类主要为心境不稳。使用青少年纵向间隔随访评估在超过 10 年内检查了各个领域的心理社会功能。
1 类在所有领域的功能均较好；4 类在所有领域的功能均较差。2 类表现为人际关系和娱乐恶化，而工作/学业改善。3 类表现为不同领域的功能下降和改善。尽管有症状缓解，13%-20%的 1 类和 20-47%的 1/3 类仍然在不同领域存在障碍。BD 发病年龄较早会影响大多数领域的障碍，而低 SES 显著预测了家庭关系的障碍。
该研究没有健康对照组来比较功能发现。
症状严重程度较高的情绪轨迹的参与者在各个领域的障碍程度更大。此外，即使有症状缓解，参与者仍存在障碍。每个类别和领域的障碍轨迹都不同。结果表明，即使在症状缓解时，检查特定（而非整体）领域对于针对性治疗也很重要。
