Cirone Carlotta, Secci Ilaria, Favole Irene, Ricci Federica, Amianto Federico, Davico Chiara, Vitiello Benedetto
Child and Adolescent Neuropsychiatry-Department of Public Health and Pediatric Sciences, Universita' degli Studi di Torino, 10126 Turin, Italy.
Child and Adolescent Neuropsychiatry-Department of Neurosciences, Universita' degli Studi di Torino, 10126 Turin, Italy.
Brain Sci. 2021 Mar 8;11(3):341. doi: 10.3390/brainsci11030341.
Early onset of psychopathology is often an index of a more severe clinical course and worse prognosis. This review examined the course of bipolar disorder (BD) with onset in childhood and adolescence, with a focus on persistence of symptoms, severity of illness, comorbidity, and functional impairment.
The databases of PubMed, Embase, and PsycInfo were systematically searched for publications since 1990 reporting on long-term (12 months or longer) assessments of patients with early onset BD.
Forty-two relevant publications were identified, which reported on data derived from 15 different patient cohorts, including 7 prospective research psychopathology studies, 4 medical record reviews, 2 follow-ups of clinical trial samples, 1 managed care database, and 1 nationwide registry, for a total of 10,187 patients. The length of follow-ups ranged from 1.0 to 15 years. Diagnostic stability of BD ranged from 73% to 100% over ten years. Recovery rate from an index episode was 81.5-100% and recurrence rate was 35-67%. Suicide attempt cumulative prevalence in five years was 18-20%. Earlier age at the first episode predicted a more severe clinical course.
Early onset BD persists over time through adolescence, with homotypic diagnostic continuity over the years, but heterogeneity in the severity of the clinical course. Whether early identification and treatment improves distal prognosis remains to be further investigated.
精神病理学的早期发作通常是临床病程更严重和预后更差的一个指标。本综述研究了儿童期和青少年期起病的双相情感障碍（BD）的病程，重点关注症状的持续性、疾病严重程度、共病情况和功能损害。
系统检索了PubMed、Embase和PsycInfo数据库中自1990年以来报告对早发性BD患者进行长期（12个月或更长时间）评估的文献。
共识别出42篇相关文献，这些文献报告了来自15个不同患者队列的数据，包括7项前瞻性研究精神病理学研究、4项病历回顾、2项临床试验样本随访、1个管理式医疗数据库和1个全国性登记处，共计10187例患者。随访时间从1.0年到15年不等。BD的诊断稳定性在十年间为73%至100%。首次发作的缓解率为81.5%至100%，复发率为35%至67%。五年内自杀未遂的累积患病率为18%至20%。首次发作年龄越早，临床病程越严重。
早发性BD在整个青春期持续存在，多年来具有同型诊断连续性，但临床病程严重程度存在异质性。早期识别和治疗是否能改善远期预后仍有待进一步研究。
