Wozniak J, Biederman J, Mundy E, Mennin D, Faraone S V
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Dec;34(12):1577-83. doi: 10.1097/00004583-199512000-00007.
To investigate the familial association of attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) among the first-degree relatives of children with comorbid ADHD and BPD.
In contrast to a growing body of literature on childhood non-bipolar depression, little is known about childhood BPD. Among the explanations accounting for the lack of recognition and identification of these children is the symptomatic overlap of BPD with ADHD. Family-genetic studies provide information external to the clinical picture and thus are uniquely suited to clarify such issues of diagnostic comorbidity.
Structured diagnostic interviews were used to obtain DSM-III-R psychiatric diagnoses on first-degree relatives (n = 46) of referred children (aged < or = 12 years) satisfying diagnostic criteria for mania using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (n = 16). For comparison, diagnostic information on the first-degree relatives of non-bipolar ADHD children and control children was examined.
The results show high rates of comorbidity between BPD and ADHD in children and high rates of both BPD and ADHD in the first-degree relatives of these children. Moreover, ADHD and BPD cosegregated among the relatives of children with BPD.
These findings, which are consistent with the authors' prior study of children with ADHD, provide family-genetic evidence for the validity of BPD and ADHD when they exist comorbidly in children. Moreover, they suggest that the comorbid condition of ADHD+BPD may be a distinct nosological entity.
研究注意缺陷多动障碍（ADHD）与双相情感障碍（BPD）共病儿童的一级亲属中ADHD和BPD的家族关联性。
与关于儿童非双相抑郁的文献不断增多形成对比的是，人们对儿童BPD了解甚少。对这些儿童缺乏认识和识别的解释之一是BPD与ADHD存在症状重叠。家族遗传学研究提供了临床症状之外的信息，因此特别适合澄清此类诊断共病问题。
采用结构化诊断访谈，对符合躁狂诊断标准的转诊儿童（年龄≤12岁）的一级亲属（n = 46）进行DSM-III-R精神疾病诊断，使用儿童情感障碍和精神分裂症检查表-流行病学版本（n = 16）。作为对照，检查了非双相ADHD儿童和对照儿童一级亲属的诊断信息。
结果显示，儿童中BPD与ADHD共病率高，这些儿童的一级亲属中BPD和ADHD的发病率也高。此外，在BPD儿童的亲属中，ADHD和BPD共同分离。
这些发现与作者先前对ADHD儿童的研究一致，为儿童中BPD和ADHD共病时的有效性提供了家族遗传学证据。此外，它们表明ADHD+BPD的共病情况可能是一个独特的疾病实体。
