Semel Institute of Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, A7-370, Los Angeles 90095, CA, USA.
School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Affect Disord. 2020 Dec 1;277:394-401. doi: 10.1016/j.jad.2020.08.018. Epub 2020 Aug 13.
Little is known about the longitudinal course of mood symptoms and functioning in youth who are at high risk for bipolar disorder (BD). Identifying distinct course trajectories and predictors of those trajectories may help refine treatment approaches.
This study examined the longitudinal course of mood symptoms and functioning ratings in 126 youth at high risk for BD based on family history and early mood symptoms. Participants were enrolled in a randomized trial of family-focused therapy and followed longitudinally (mean 2.0 years, SD = 53.6 weeks).
Using latent class growth analyses (LCGA), we observed three mood trajectories. All youth started the study with active mood symptoms. Following the index mood episode, participants were classified as having a "significantly improving course" (n = 41, 32.5% of sample), a "moderately symptomatic course" (n = 21, 16.7%), or a "predominantly symptomatic course" (n = 64, 50.8%) at follow-up. More severe depression, anxiety, and suicidality at the study's baseline were associated with a poorer course of illness. LCGA also revealed three trajectories of global functioning that closely corresponded to symptom trajectories; however, fewer youth exhibited functional recovery than exhibited symptomatic recovery.
Mood trajectories were assessed within the context of a treatment trial. Ratings of mood and functioning were based on retrospective recall.
This study suggests considerable heterogeneity in the course trajectories of youth at high risk for BD, with a significant proportion (32.5%) showing long-term remission of symptoms. Treatments that enhance psychosocial functioning may be just as important as those that ameliorate symptoms in youth at risk for BD.
对于有双相情感障碍（BD）高风险的年轻人，其心境症状和功能的纵向病程知之甚少。确定不同的病程轨迹及其预测因素可能有助于完善治疗方法。
本研究根据家族史和早期心境症状，对 126 名有 BD 高风险的年轻人进行了心境症状和功能评定的纵向病程研究。参与者参加了家庭为中心的治疗的随机试验，并进行了纵向随访（平均 2.0 年，SD=53.6 周）。
使用潜在类别增长分析（LCGA），我们观察到三种心境轨迹。所有年轻人在研究开始时都有活跃的心境症状。在首发心境发作后，根据随访时的情况，参与者被分为“显著改善病程”（n=41，占样本的 32.5%）、“中度症状病程”（n=21，16.7%）或“主要症状病程”（n=64，50.8%）。研究基线时更严重的抑郁、焦虑和自杀意念与较差的疾病病程相关。LCGA 还揭示了三种与症状轨迹密切对应的总体功能轨迹；然而，与表现出症状恢复的年轻人相比，表现出功能恢复的年轻人较少。
心境轨迹是在治疗试验的背景下进行评估的。心境和功能的评定基于回顾性回忆。
这项研究表明，有 BD 高风险的年轻人的病程轨迹存在相当大的异质性，其中相当一部分（32.5%）表现出症状的长期缓解。增强心理社会功能的治疗方法可能与改善有 BD 风险的年轻人的症状一样重要。
