Kovacs M, Pollock M
University of Pittsburgh School of Medicine, PA, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Jun;34(6):715-23. doi: 10.1097/00004583-199506000-00011.
To report on the rate and associated features of comorbid conduct disorder (CD) in 26 bipolar (BP) youths and examine whether comorbidity affects clinical course.
The clinically referred subjects, 8 to 13 years old at study entry, were participating in a longitudinal investigation of childhood-onset psychiatric disorders. They were repeatedly examined during an interval of up to 12 years, and diagnosed by DSM-III criteria.
There was a 69% rate of lifetime comorbidity and 54% rate of episode comorbidity with CD. CD predated the first BP episode for 11 youths and postdated it for 7. Only 12% of the 26 children had primary uncomplicated affective illness. Youngsters without CD comorbidity had a higher rate of primary affective illness, a somewhat greater number of BP episodes, but slightly better overall clinical course. They also had a greatly elevated rate of maternal mania, whereas BP youths with CD were notable for the rate of paternal substance abuse.
Comorbid CD may exist in a large portion of young patients with BP disorder, confusing its clinical presentation and possibly accounting for some of the documented failure to detect BP disorder. Comorbid CD in bipolar youths appears to be associated with a somewhat worse clinical course. The overall indications are that comorbid CD may identify a subtype of very early onset BP disorder.
报告26例双相情感障碍（BP）青少年中合并品行障碍（CD）的发生率及相关特征，并探讨共病是否会影响临床病程。
临床转诊的受试者在研究开始时年龄为8至13岁，他们参与了一项儿童期起病的精神障碍纵向调查。在长达12年的时间间隔内对他们进行了多次检查，并根据《精神疾病诊断与统计手册》第三版（DSM-III）标准进行诊断。
终生共病率为69%，发作期共病率为54%。11名青少年的CD先于首次BP发作，7名青少年的CD后于首次BP发作。26名儿童中只有12%患有原发性单纯情感性疾病。无CD共病的青少年原发性情感性疾病的发生率较高，BP发作次数略多，但总体临床病程稍好。他们的母亲患躁狂症的比率也大大升高，而患有CD的BP青少年则以父亲药物滥用比率高为显著特征。
合并CD可能存在于很大一部分患有BP障碍的年轻患者中，这会混淆其临床表现，并可能是一些文献中记录的未能检测出BP障碍的原因之一。双相情感障碍青少年合并CD似乎与稍差的临床病程相关。总体迹象表明，合并CD可能识别出一种极早发BP障碍的亚型。
