Bipolar Collaborative Network, Professor of Psychiatry George Washington Medical School, Bethesda, MD, Washington, DC, United States.
Departments of Psychiatry and Pharmacology, University of Toronto; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Canada.
J Affect Disord. 2020 Jul 1;272:508-520. doi: 10.1016/j.jad.2020.03.025. Epub 2020 Mar 6.
Despite the well-documented negative impact of untreated bipolar illness, approaches to early intervention in childhood-onset bipolar and related disorders are not well delineated.
We reviewed the extant treatment literature on children at high risk for bipolar disorder, with definitions based on family history, childhood adversity, and prodromal symptoms.
A panoply of approaches have been described, but most interventions are based on an inadequate database to support their routine implementation. We classify early stage interventions as a function of their safety and tolerability with the hope that these might generate more rigorous study and a stronger database.
Critics may rightly argue that identifying viable treatment methods is premature given our lack of ability to reliably predict illness trajectory in very young children. However, many of the psychosocial and pharmacological interventions we present could have nonspecific positive effects across a variety of symptoms, syndromes, and diagnoses, further enhancing the rationale for more rigorous study.
Early stage interventions have the potential to improve functioning in prodromal illness and exert long-term positive effects on the course of illness. Many of the safest interventions deserve consideration for implementation and dissemination studies.
尽管未经治疗的双相情感障碍所带来的负面影响有案可查，但儿童期发病的双相及相关障碍的早期干预方法仍不明确。
我们回顾了基于家族史、儿童期逆境和前驱症状对双相障碍高危儿童的现有治疗文献。
已经描述了多种方法，但大多数干预措施都是基于不足的数据库，无法支持其常规实施。我们根据安全性和耐受性对早期干预进行分类，希望这些方法能产生更严格的研究和更强有力的数据库。
批评者可能会认为，鉴于我们无法可靠地预测幼儿的疾病轨迹，确定可行的治疗方法还为时过早。然而，我们提出的许多心理社会和药物干预措施可能对各种症状、综合征和诊断具有非特异性的积极影响，进一步增强了更严格研究的理由。
早期干预有可能改善前驱期疾病的功能，并对疾病的病程产生长期的积极影响。许多最安全的干预措施值得考虑进行实施和传播研究。
