Akiskal H S
University of California at San Diego, La Jolla 92093-0603, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Jun;34(6):754-63. doi: 10.1097/00004583-199506000-00016.
This article approaches the question of bipolarity in childhood and adolescence from an "adult" perspective. It argues that clinically ascertained juvenile depressions--with onsets typically in late childhood or early adolescence--have affinity to bipolar spectrum disorders based on (1) early age at onset; (2) even gender ratio; (3) prominence of irritability, labile moods, and explosive anger indicative of mixed episodes; (4) high rates of "comorbid" substance abuse; (5) questionable response to antidepressants and/or brief hypomanic switches; (6) high rates of recurrence; (7) familial affective loading; and (8) frequent superposition on affective temperamental dysregulation. Building on the last point, the author submits that dysthymic, cyclothymic, and hyperthymic temperaments represent putative developmental pathways to bipolarity (as contrasted to "inhibited" anxious-phobic types, which appear related to nonbipolar outcomes.
本文从“成人”视角探讨儿童期和青少年期的双相情感障碍问题。文章认为，临床上确诊的青少年抑郁症——通常起病于儿童晚期或青少年早期——与双相情感障碍谱系障碍存在关联，依据如下：（1）起病年龄早；（2）性别比例均衡；（3）易激惹、情绪不稳定和爆发性愤怒较为突出，提示混合发作；（4）“共病”物质滥用发生率高；（5）对抗抑郁药的反应存疑和/或出现短暂轻躁狂发作；（6）复发率高；（7）家族情感负荷；（8）常叠加情感气质性失调。基于最后一点，作者提出心境恶劣、环性心境和轻躁狂气质代表了通向双相情感障碍的假定发展路径（与“抑制性”焦虑 - 恐惧型相反，后者似乎与非双相情感障碍结局相关）。
