Masi Gabriele, Berloffa Stefano, Muratori Pietro, Mucci Maria, Viglione Valentina, Villafranca Arianna, Inguaggiato Emanuela, Levantini Valentina, Placini Francesca, Pfanner Chiara, D'Acunto Giulia, Lenzi Francesca, Liboni Francesca, Milone Annarita
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56028 Calambrone-Pisa, Italy.
Brain Sci. 2020 Sep 29;10(10):689. doi: 10.3390/brainsci10100689.
Bipolar Disorders (BD) in youth are a heterogeneous condition with different phenomenology, patterns of comorbidity and outcomes. Our aim was to explore the effects of gender; age at onset (prepubertal- vs. adolescent-onset) of BD; and elements associated with attention deficit hyperactivity disorder (ADHD) and Substance Use Disorder (SUD) comorbidities, severe suicidal ideation or attempts, and poorer response to pharmacological treatments.
117 youth (69 males and 57 females, age range 7 to 18 years, mean age 14.5 ± 2.6 years) consecutively referred for (hypo)manic episodes according to the , 54th ed (DSM 5) were included.
Gender differences were not evident for any of the selected features. Prepubertal-onset BD was associated with higher rates of ADHD and externalizing disorders. SUD was higher in adolescent-onset BD and was associated with externalizing comorbidities and lower response to treatments. None of the selected measures differentiated patients with or without suicidality. At a 6-month follow up, 51.3% of the patients were responders to treatments, without difference between those receiving and not receiving a psychotherapy. Clinical severity at baseline and comorbidity with Conduct Disorder (CD) and SUD were associated with poorer response. Logistic regression indicated that baseline severity and number of externalizing disorders were associated with a poorer outcome.
Disentangling broader clinical conditions in more specific phenotypes can help timely and focused preventative and therapeutic interventions.
青少年双相情感障碍（BD）是一种异质性疾病，具有不同的临床表现、共病模式和预后。我们的目的是探讨性别、BD起病年龄（青春期前起病与青春期起病）以及与注意力缺陷多动障碍（ADHD）和物质使用障碍（SUD）共病、严重自杀观念或企图以及对药物治疗反应较差相关的因素。
纳入117名青少年（69名男性和57名女性，年龄范围7至18岁，平均年龄14.5±2.6岁），这些青少年根据第54版《精神疾病诊断与统计手册》（DSM-5）被连续转诊至（轻）躁狂发作门诊。
在所选择的任何特征方面，性别差异均不明显。青春期前起病的BD与ADHD和外化性障碍的较高发生率相关。青春期起病的BD中SUD发生率较高，且与外化性共病和较低的治疗反应相关。所选择的任何指标均无法区分有或无自杀倾向的患者。在6个月的随访中，51.3%的患者对治疗有反应，接受和未接受心理治疗的患者之间无差异。基线时的临床严重程度以及与品行障碍（CD）和SUD的共病与较差的反应相关。逻辑回归表明，基线严重程度和外化性障碍的数量与较差的预后相关。
在更具体的表型中区分更广泛的临床情况有助于及时且有针对性地进行预防和治疗干预。
