Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Mental Health Services Capital Region, Copenhagen, Denmark.
Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
Acta Psychiatr Scand. 2023 Aug;148(2):110-132. doi: 10.1111/acps.13548. Epub 2023 Mar 28.
A growing body of evidence suggests that pediatric bipolar disorder (PBD) frequently co-occurs with comorbid psychiatric disorders that may impact functioning.
To review existing literature on the prevalence of psychiatric comorbidity and general functioning in patients with a primary diagnosis of PBD.
We performed a systematic literature search on the PubMed, Embase and PsycInfo databases on November 16th, 2022. We included original papers on patients ≤18 years with primary PBD and any comorbid psychiatric disorder, diagnosed according to a validated diagnostic tool. Risk of bias of the individual studies was assessed using the STROBE checklist. We calculated weighted means to assess the comorbidity prevalence. The review complied with PRISMA statement guidelines.
Twenty studies with a total study population of 2722 patients with PBD were included (mean age = 12.2 years). We found an overall high prevalence of comorbidity in patients with PBD. The most common comorbidities were attention-deficit-hyperactivity disorder (ADHD) (60%) and oppositional defiant disorder (ODD) (47%). Anxiety disorders, obsessive-compulsive disorder, conduct disorder, tic disorders and substance-related disorders affected between 13.2% and 29% of patients, while one in 10 had comorbid mental retardation or autism spectrum disorder (ASD). The prevalence of comorbid disorders was lower in studies that assessed the current prevalence in patients in full or partial remission. General functioning was overall not specifically decreased in patients with comorbidity.
Comorbidity across a broad range of disorders was high in children diagnosed with PBD, especially regarding ADHD, ASD, behavioral and anxiety disorders including OCD. Future original studies should assess current prevalence of comorbidities in patients with PBD who are in remission to obtain more reliable estimates of psychiatric comorbidity in this patient group. The review highlights the clinical and scientific importance of comorbidity in PBD.
越来越多的证据表明，儿童双相情感障碍（PBD）常与合并的精神疾病共病，这可能会影响其功能。
综述原发性 PBD 患者合并精神疾病和一般功能的现有文献。
我们于 2022 年 11 月 16 日在 PubMed、Embase 和 PsycInfo 数据库中进行了系统文献检索。我们纳入了符合以下标准的原始论文：≤18 岁的患者，有原发性 PBD 和任何合并的精神疾病，根据经过验证的诊断工具进行诊断。使用 STROBE 清单评估个体研究的偏倚风险。我们计算了加权均值来评估合并症的患病率。该综述符合 PRISMA 声明指南。
纳入了 20 项研究，共有 2722 例 PBD 患者，（平均年龄为 12.2 岁）。我们发现 PBD 患者合并症的总体患病率较高。最常见的合并症是注意力缺陷多动障碍（ADHD）（60%）和对立违抗性障碍（ODD）（47%）。焦虑障碍、强迫症、品行障碍、抽动障碍和物质相关障碍的患病率在 13.2%至 29%之间，而 10%的患者有合并智力障碍或自闭症谱系障碍（ASD）。在评估完全或部分缓解患者当前患病率的研究中，合并症的患病率较低。总体而言，合并症患者的一般功能并未明显下降。
在被诊断为 PBD 的儿童中，广泛的疾病共病率较高，尤其是 ADHD、ASD、行为和焦虑障碍，包括强迫症。未来的原始研究应评估处于缓解期的 PBD 患者的合并症当前患病率，以获得该患者群体中合并症更可靠的估计。该综述强调了 PBD 中合并症的临床和科学重要性。
