사춘기 이전 발병 양극성 장애의 임상적 특성
Clinical Characteristics of Bipolar Disorder Patients with Prepubertal Onset - A Pilot Study
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
소아청소년기에도 양극성 정동장애가 발병하는 것으로 알려져 있지만 이에 대한 정확한 유병률과 진단 방법, 평가 척도에 관한 국내 연구는 별로 없다. 본 연구에서 사춘기 이전 양극성 장애는 비특이적인 혼재성 삽화를 보이고 만성적인 경과를 보이며 DSM-IV의 진단기준을 충족시키지 않았다. 대상자의 반수 정도가 양극성 장애 진단 이전에 중추신경자극제, 항우울제 등으로 치료 받는 등 적절한 조기 개입이 이루어지지 않았다. 사춘기 이전 발병 양극성 장애의 경우 환자의 학업적, 사회적 기능의 심각한 저하를 일으킬 수 있어 조기진단, 적절한 개입이 매우 중요하다. 이를 위해 소아기 양극성 장애의 진단 방법, 임상적 표현형, 약물 치료에 대한 활발한 연구가 필요하다.
Abstract
Objectives: This case-based, small scale study was undertaken to identify the characteristics clinical features of children who exhbiit rare prepubertal onset bipolar disorder. Methods: We analyzed the clinical records of 13 children who had been hospitalized and diagnosed with bipolar disorder. Clinical characteristics and cognitive function of these patients was based on psychiatrists’ medical records and psychologists’ evaluation reports. Results: Eleven (84.6%) subjects exhibited clinical features of mixed mania and had a chronic clinical course. They never fulfilled the full criteria of the Diagnostic Statistical Manual of Mental disorders-Fourth Edition (DSM-IV) for manic or hypomanic episodes. Mean age at onset of typical symptoms of bipolar disorder was 9.38 (SD=1.80) and mean age at admission was 12.00 (SD=2.45). Twelve(92.3%) had psychiatric comorbidity. Attention-deficit/hyperactivity disorder was the most prevalent comorbid disease and mean age of onset of it was 6.23 (SD=2.17). Conclusion: Subjects with prepubertal onset bipolar disorder showed atypical clinical features. These results suggest that most prepubertal onset bipolar disorder patients fail to meet the DSM-IV criteria for typical bipolarⅠdisorder and therefore, we need to develop alternative diagnostic criteria for pediatric bipolar disorder.
참고문헌 (29)
- Dame C, "Bipolar disorder in children and adolescents", Rev Med Brux, 27, pp.437~443 (2006)
- Pavuluri MN, "Pediatric bipolar disorder: a review of the past 10 years", J Am Acad Child Adolesc Psychiatry, 44, pp.846~871 (2005)
- Leibenluft E, "Defining clinical phenotypes of juvenile mania", Am J Psychiatry, 160, pp.430~437 (2003)
- Geller B, "Complex and rapid-cycling in bipolar children and adolescents: a preliminary study", J Affect Disord, 34, pp.259~268 (1995)
- Wozniak J, "Diagnostic and therapeutic dilemmas in the management of pediatric-onset bipolar disorder", J Clin Psychiatry, 62(14), pp.101~15 (2001)
- Faedda GL, "Pediatric bipolar disorder: phenomenology and course of illness", Bipolar Disord, 6, pp.305~313 (2004)
- Jolin EM, "Prepubertal bipolar disorder: proper diagnosis should lead to better treatment response", Curr Psychiatry Rep, 7, pp.104~111 (2005)
- "National Institute of Mental Health research roundtable on prepubertal bipolar disorder", J Am Acad Child Adolesc Psychiatry, 40, pp.871~878 (2001)
- 천근아, "한국판 소아 양극성장애 설문지 2.0(Child Bipolar Questionnaire 2.0)의 신뢰도 및 타당도 연구", 신경정신의학, 47(3), pp.269~278 (2008), 대한신경정신의학회
- Horlick M, "Body composition changes during Tanner stage 5", Ann N Y Acad Sci, 904, pp.410~415 (2000)
- 곽금주, "한국 웩슬러아동지능검사 (K-WISC-3) 표준화연구 (1): 신뢰도와 구성타당도", 한국심리학회지: 발달, 15(1), pp.19~33 (2002), 한국심리학회 산하 한국발달심리학회
- Development of Korean version of Child Behavior Checklist (K-CBCL), "Oh KJ", Korean Research Foundation, ~ (1990)
- Egeland JA, "Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories", J Am Acad Child Adolesc Psychiatry, 39, pp.1245~1252 (2000)
- Tillman R, "Diagnostic characteristics of child bipolar I disorder: does the "Treatment of Early Age Mania (team)" sample generalize?", J Clin Psychiatry, 68, pp.307~314 (2007)
- Townsend LD, "Update on pediatric bipolar disorder", Curr Psychiatry Rep, 9, pp.529~534 (2007)
- Wozniak J, "How cardinal are cardinal symptoms in pediatric bipolar disorder? An examination of clinical correlates", Biol Psychiatry, 58, pp.583~588 (2005)
- Geller B, "Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype", Arch Gen Psychiatry, 61, pp.459~467 (2004)
- Geller B, "Prepubertal and young adolescent bipolarity versus ADHD: assessment and validity using the WASH-U-KSADS, CBCL and TRF", J Affect Disord, 51, pp.93~100 (1998)
- Geller B, "DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls", J Child Adolesc Psychopharmacol, 12, pp.11~25 (2002)
- Carlson GA, "Child and adolescent mania--diagnostic considerations", J Child Psychol Psychiatry, 31, pp.331~341 (1990)
- Bertelsen A, "Gottesman II Schizoaffective psychoses: genetical clues to classification", Am J Med Genet, 60, pp.7~11 (1995)
- Wozniak J, "A pilot family study of childhood-onset mania", J Am Acad Child Adolesc Psychiatry, 34, pp.1577~1583 (1995)
- Strober M, "A family study of bipolar I disorder in adolescence. Early onset of symptoms linked to increased familial loading and lithium resistance", J Affect Disord, 15, pp.255~268 (1988)
- Chang KD, "Psychiatric phenomenology of child and adolescent bipolar offspring", J Am Acad Child Adolesc Psychiatry, 39, pp.453~460 (2000)
- American Psychiatric Association, "Practice guideline for the treatment of patients with bipolar disorder (revision)", Am J Psychiatry, 159, pp.1~50 (2002)
- Chang KD, "Mood stabilizer augmentation with olanzapine in acutely manic children", J Child Adolesc Psychopharmacol, 10, pp.45~49 (2000)
- Koehler-Troy C, "Methylphenidate-induced mania in a prepubertal child", J Clin Psychiatry, 47, pp.566~567 (1986)
- Baumer FM, "A pilot study of antidepressant-induced mania in pediatric bipolar disorder: characteristics, risk factors, and the serotonin transporter gene", Biol Psychiatry, 60, pp.1005~1012 (2006)
- Kat H, "More on SSRI-induced mania", J Am Acad Child Adolesc Psychiatry, 35, pp.975~ (1996)