Weller E B, Weller R A, Fristad M A
Department of Psychiatry, Ohio State University, Columbus, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Jun;34(6):709-14. doi: 10.1097/00004583-199506000-00010.
Bipolar disorder has not been well studied in prepubertal children, despite its potentially debilitating effects on growth and development. However, there have been case reports of mania in this age group dating back to Esquirol in the mid-19th century. Despite anecdotal case reports, explicit criteria to diagnose mania in children were not used until 1960. Since 1980 the DSM-III/DSM-III-R criteria have indicated adult criteria can be used to diagnose childhood mania, with some modifications to adjust for age differences. Bipolar disorder has not been frequently considered in the psychiatric differential diagnosis of children. However, if a diagnosis of mania is made, clinical rating scales can be used to rate the severity of manic symptoms and to monitor treatment. A manic child should be treated using a biopsychosocial approach. To date, lithium carbonate has been the most commonly used psychopharmacological treatment, but results have been variable. Additional research is needed, including double-blind, placebo-controlled studies to document the beneficial effects of mood-stabilizing medications. Also, diagnostic instruments should be refined to improve their utility. Finally, children at high risk for developing mania should be studied to identify predictors of bipolar disorder in children.
尽管双相情感障碍对青春期前儿童的生长发育可能产生严重的不良影响，但针对这一年龄段儿童的相关研究却十分匮乏。然而，早在19世纪中叶，埃斯基罗尔（Esquirol）就已报道过该年龄段儿童的躁狂病例。尽管有个别病例报告，但直到1960年才有明确的儿童躁狂诊断标准。自1980年起，《精神疾病诊断与统计手册》第三版（DSM-III）/第三版修订本（DSM-III-R）的标准表明，成人标准可用于诊断儿童躁狂，但需进行一些调整以适应年龄差异。在儿童的精神科鉴别诊断中，双相情感障碍并不常被考虑。然而，如果确诊为躁狂，临床评定量表可用于评估躁狂症状的严重程度并监测治疗效果。对于躁狂儿童，应采用生物心理社会治疗方法。迄今为止，碳酸锂一直是最常用的精神药物治疗，但疗效不一。还需要进一步的研究，包括双盲、安慰剂对照研究，以证明心境稳定剂的有益效果。此外，应改进诊断工具以提高其效用。最后，应对有躁狂发作高风险的儿童进行研究，以确定儿童双相情感障碍的预测因素。
