Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
J Am Acad Child Adolesc Psychiatry. 2022 Oct;61(10):1285-1295. doi: 10.1016/j.jaac.2022.03.009. Epub 2022 Mar 17.
Mood instability is associated with the onset of bipolar disorder (BD) in youth with a family history of the illness. In a clinical trial with youth at high risk for BD, we examined the association between mood instability and symptomatic, psychosocial, and familial functioning over an average of 2 years.
Youth (aged 9-17 years) with major depressive disorder or other specified BD, current mood symptoms, and a family history of BD were rated by parents on a mood instability scale. Participants were randomly assigned to 4 months of family-focused therapy or enhanced care psychoeducation, both with medication management as needed. Independent evaluators rated youth every 4-6 months for up to 4 years on symptom severity and psychosocial functioning, whereas parents rated mood instability of the youth and levels of family conflict.
High-risk youth (N = 114; mean age 13.3 ± 2.6 years; 72 female) were followed for an average of 104.3 ± 65.8 weeks (range, 0-255 weeks) after randomization. Youth with other specified BD (vs major depressive disorder), younger age, earlier symptom onset, more severe mood symptoms, lower psychosocial functioning, and more familial conflict over time had higher mood instability ratings throughout the study period. Mood instability mediated the association between baseline diagnosis and mother/offspring conflict at follow-up (Z = 2.88, p = .004, αβ = 0.19, 95% CI = 0.06-0.32). Psychosocial interventions did not moderate these associations.
A questionnaire measure of mood instability tracked closely with symptomatic, psychosocial, and family functioning in youth at high risk for BD. Interventions that are successful in reducing mood instability may enhance long-term outcomes among high-risk youth.
Early Intervention for Youth at Risk for Bipolar Disorder; https://clinicaltrials.gov/; NCT01483391.
情绪不稳定与有家族病史的青年双相情感障碍（BD）的发病有关。在一项针对有 BD 高风险的青年的临床试验中，我们研究了情绪不稳定与症状、心理社会和家庭功能之间的关联，平均随访时间为 2 年。
父母对患有重性抑郁障碍或其他特定 BD、当前有情绪症状且有 BD 家族史的 9-17 岁青少年进行情绪不稳定量表评定。参与者随机分配到 4 个月的家庭为中心的治疗或强化关怀心理教育，两者都需要药物管理。独立评估者每 4-6 个月对青少年进行症状严重程度和心理社会功能评估，最长可达 4 年，而父母则对青少年的情绪不稳定和家庭冲突水平进行评定。
高危青少年（N=114；平均年龄 13.3±2.6 岁；72 名女性）在随机分组后平均随访 104.3±65.8 周（范围，0-255 周）。与重性抑郁障碍相比，其他特定 BD（vs 重性抑郁障碍）、年龄较小、发病较早、情绪症状较严重、心理社会功能较差以及家庭冲突随时间推移而增加的青少年在整个研究期间情绪不稳定评分更高。情绪不稳定在基线诊断与随访时母亲/子女冲突之间的关联中起中介作用（Z=2.88，p=0.004，αβ=0.19，95%置信区间=0.06-0.32）。心理社会干预并没有调节这些关联。
情绪不稳定问卷测量与有 BD 高风险的青少年的症状、心理社会和家庭功能密切相关。成功降低情绪不稳定的干预措施可能会改善高危青少年的长期结局。
早期干预有双相情感障碍风险的青年；https://clinicaltrials.gov/；NCT01483391。
