Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
J Affect Disord. 2023 May 15;329:300-306. doi: 10.1016/j.jad.2023.02.119. Epub 2023 Mar 1.
Conduct Disorder (CD) is highly comorbid with Bipolar Disorder (BP) and this comorbidity is associated with high morbidity and dysfunction. We sought to better understand the clinical characteristics and familiality of comorbid BP + CD by examining children with BP with and without co-morbid CD.
357 subjects with BP were derived from two independent datasets of youth with and without BP. All subjects were evaluated with structured diagnostic interviews, the Child Behavior Checklist (CBCL), and neuropsychological testing. We stratified the sample of subjects with BP by the presence or absence of CD and compared the two groups on measures of psychopathology, school functioning, and neurocognitive functioning. First-degree relatives of subjects with BP +/- CD were compared on rates of psychopathology in relatives.
Subjects with BP + CD compared to BP without CD had significantly more impaired scores on the CBCL Aggressive Behavior (p < 0.001), Attention Problems (p = 0.002), Rule-Breaking Behavior (p < 0.001), Social Problems (p < 0.001), Withdrawn/Depressed clinical scales (p = 0.005), the Externalizing Problems (p < 0.001), and Total Problems composite scales(p < 0.001). Subjects with BP + CD had significantly higher rates of oppositional defiant disorder (ODD) (p = 0.002), any SUD (p < 0.001), and cigarette smoking (p = 0.001). First-degree relatives of subjects with BP + CD had significantly higher rates of CD/ODD/ASPD and cigarette smoking compared to first-degree relatives of subjects without CD.
The generalization of our findings was limited due to a largely homogeneous sample and no CD only comparison group.
Given the deleterious outcomes associated with comorbid BP + CD, further efforts in identification and treatment are necessary.
品行障碍（CD）与双相障碍（BP）高度共病，这种共病与高发病率和功能障碍有关。我们试图通过检查患有 BP 且伴有或不伴有共病 CD 的儿童，更好地了解共病 BP+CD 的临床特征和家族性。
从两个独立的有和无 BP 的青少年数据集，得出 357 名患有 BP 的受试者。所有受试者均接受结构化诊断访谈、儿童行为检查表（CBCL）和神经心理学测试。我们根据 CD 的存在与否对 BP 受试者样本进行分层，并比较两组在精神病理学、学校功能和神经认知功能方面的指标。比较有和无 CD 的 BP 受试者的一级亲属在亲属中的精神病理学发生率。
与无 CD 的 BP 相比，患有 CD+BP 的受试者在 CBCL 攻击性行为（p<0.001）、注意力问题（p=0.002）、违规行为（p<0.001）、社会问题（p<0.001）、退缩/抑郁临床量表（p=0.005）、外化问题（p<0.001）和总问题综合量表（p<0.001）上的评分明显受损。患有 CD+BP 的受试者对立违抗性障碍（ODD）（p=0.002）、任何物质使用障碍（SUD）（p<0.001）和吸烟（p=0.001）的发生率明显较高。患有 CD+BP 的受试者的一级亲属中 CD/ODD/ASPD 和吸烟的发生率明显高于无 CD 的受试者的一级亲属。
由于样本大多同质且没有仅 CD 对照组，我们的发现的推广受到限制。
鉴于共病 BP+CD 与不良后果相关，需要进一步努力进行识别和治疗。
