Vila G, Robert J J, Jos J, Mouren-Simeoni M C
Service de psychiatrie de l'enfant et de l'adolescent, hôpital Necker-Enfants-Malades, Paris, France.
Arch Pediatr. 1997 Jul;4(7):615-22. doi: 10.1016/s0929-693x(97)83358-1.
To assess the type of mental disorders met in the medical follow-up of insulin-dependent diabetic children (IDDM) and adolescents and their relationships with metabolic control (HbA1C) in young IDDM patients who consult in a department of child psychiatry.
Twenty boys and 37 girls (mean age: 14.7 +/- 4.1 years and mean duration of IDDM: 5.6 +/- 4.3 years were followed during 1 year by the same child psychiatrist (mean duration of follow-up: 22 months). They were assessed with several clinical interviews (mean: three by subject); mental disorders were classified according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (DSM III-R).
The study showed the importance of emotional disorders, 30 patients presenting at least an anxiety disorder and 17 an affective disorder, 11 a major depressive disorder and eight a dysthymic disorder. The most frequent anxiety disorders were phobias and overanxious disorders. Two patients had an anorexia nervosa, one a bulimia nervosa and nine an eating disorder not otherwise specified. There were ten diagnoses of disruptive behaviour disorders, one toxic substance abuse and 11 adaptation disorders. Seven subjects had a reading and writing learning disorder, three a coordination disorder and three a borderline IQ. Familial factors seemed very important. Nine patients had a parent-child problem, four sibling rivalry disorder and two an attachment disorder. Family problems (conflicts, separations, economical difficulties...) were found in 63% of cases. The mother or the father had mental disorders in 24 cases (42%). The diabetic patients with mental disorders had poor metabolic control (HbA1C = 9.9 +/- 2.4%) and ten subjects (18%) had already somatic complications. Some mental disorders were significantly associated with high HbA1C. The poorer metabolic controls were observed for eating disorders. Somatic complications were associated only with IDDM duration.
This study shows the presence of typical DSM III-R mental disorders in IDDM children and adolescents, principally emotional disorders, and their association with a higher somatic risk, maximum for eating disorders. It shows the interest of collaboration between diabetologist and child psychiatrist. The exact prevalence of these disorders should be assessed by epidemiological studies.
为评估在儿童精神科就诊的胰岛素依赖型糖尿病儿童（IDDM）和青少年的医学随访中所遇到的精神障碍类型，以及这些障碍与年轻IDDM患者代谢控制（糖化血红蛋白HbA1C）之间的关系。
20名男孩和37名女孩（平均年龄：14.7±4.1岁，IDDM平均病程：5.6±4.3年）由同一名儿童精神科医生随访1年（平均随访时长：22个月）。对他们进行了多次临床访谈（平均每人3次）；精神障碍根据《精神障碍诊断与统计手册》第三版修订本（DSM III-R）的标准进行分类。
研究表明情绪障碍较为常见，30名患者至少患有一种焦虑症，17名患有情感障碍，11名患有重度抑郁症，8名患有心境恶劣障碍。最常见的焦虑症是恐惧症和过度焦虑症。两名患者患有神经性厌食症，一名患有神经性贪食症，九名患有未另行规定的进食障碍。有10例破坏性行为障碍诊断，1例药物滥用，11例适应障碍。7名受试者有读写学习障碍，3名有协调障碍，3名智商处于临界水平。家庭因素似乎非常重要。9名患者存在亲子问题，4名有同胞竞争障碍，2名有依恋障碍。63%的病例存在家庭问题（冲突、分居、经济困难等）。24例（42%）患者的母亲或父亲患有精神障碍。患有精神障碍的糖尿病患者代谢控制较差（HbA1C = 9.9±2.4%），10名受试者（18%）已经出现躯体并发症。一些精神障碍与高HbA1C显著相关。进食障碍患者的代谢控制更差。躯体并发症仅与IDDM病程有关。
本研究表明IDDM儿童和青少年中存在典型的DSM III-R精神障碍，主要是情绪障碍，且这些障碍与更高的躯体风险相关，进食障碍的风险最高。这表明糖尿病专家和儿童精神科医生合作的意义。这些障碍的确切患病率应通过流行病学研究进行评估。
