Wozniak J, Biederman J
Pediatric Psychopharmacology Unit of the Child Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
J Assoc Acad Minor Phys. 1997;8(4):78-84.
Our study's objective was to clarify the nosologic status of children who satisfy diagnostic criteria for bipolar disorder. Using blind raters and structured psychiatric interviews as well as data from other instruments, we undertook studies from various vantage points, examining children with bipolar disorder to confirm the existence of the diagnosis in children and to clarify its clinical course and characteristics. We found that (1) bipolar disorder in children referred to our clinical center is not as rare as previously thought; (2) bipolar disorder in children commonly presents with attention-deficit hyperactivity disorder, which makes diagnosis difficult; and (3) bipolar disorder in children presents with a clinical picture considered atypical by adult standards, with irritability, chronicity, and symptoms of mania mixed with those of depression. Our data suggest that childhood bipolar disorder is more common than previously thought, but it may be difficult to diagnose because of comorbidity with attention-deficit hyperactivity disorder and a developmentally different presentation from adults.
我们研究的目的是明确符合双相情感障碍诊断标准的儿童的疾病分类状况。我们使用盲法评估者和结构化精神科访谈以及来自其他工具的数据，从多个有利视角开展研究，对双相情感障碍儿童进行检查，以确认儿童双相情感障碍诊断的存在，并阐明其临床病程和特征。我们发现：（1）转诊至我们临床中心的儿童双相情感障碍并不像之前认为的那么罕见；（2）儿童双相情感障碍常伴有注意力缺陷多动障碍，这使得诊断困难；（3）儿童双相情感障碍呈现出一种按照成人标准被认为是非典型的临床表现，具有易激惹、慢性病程以及躁狂症状与抑郁症状相混合的特点。我们的数据表明，儿童双相情感障碍比之前认为的更为常见，但由于与注意力缺陷多动障碍共病以及其临床表现与成人在发育上存在差异，可能难以诊断。
