双相障碍患者童年期行为问题的临床研究  

Childhood behavior problems in patients with bipolar disorder

作　　者：汤珺[1] 苏林雁[1] 张尧[2] 张淑芳[2] 姜文娟[2] 吕路[2] 刘伟[2] 向东方[2] 王鹏[2] 吴江[2] 

机构地区：[1]中南大学湘雅二医院精神卫生研究所,长沙430022410011 [2]武汉市精神卫生中心,华中科技大学同济医学院430030

出　　处：《中华精神科杂志》2006年第3期133-136,共4页Chinese Journal of Psychiatry

摘　　要：目的 探讨双相障碍（BPD）患者在儿童早期的行为特征及其与注意缺陷多动障碍（ADHD）的关系。方法 使用美国精神障碍诊断与统计手册第4版中ADHD诊断标准、Achenbach儿童行为量表（CBCL）对64例BPD患者（BPD组）儿童期的行为进行诊断和评估，并与64例内科疾病患者（对照组）进行对照。结果 （1）BPD组有12例（19％）童年期符合ADHD诊断标准，高于对照组（2例，3％；χ^2=8．020，P=0．005）。（2）BPD组中，有无精神病家族史的患者童年期发生ADHD者分别为4例（25％）和8例（17％），差异无统计学意义（P〉0．05）。（3）BPD组中有无ADHD者的发病年龄分别为（18±4）岁和（20±5）岁，差异无统计学意义（P〉0．05）。（4）童年期CBCL得分，BPD组的退缩、焦虑／抑郁、思维问题、违纪行为、攻击性行为、内化性问题、外化性问题、行为问题总分均高于对照组（P〈0．01）；BPD组中有ADHD病史组（12例，19％）的注意问题、攻击性行为、外化性问题、行为问题总分高于无ADHD病史组（52例，81％；P〈0．05和P〈0．01）。结论 BPD患者在童年期有更高的ADHD发生率和较多的行为问题；有ADHD病史者童年期可能存在更多的注意力受损和外化性问题。Objective To explore the childhood behavior characters of patients with bipolar disorder （BPD） and the relationship between BPD and attention deficit hyperactivity disorder （ADHD）. Methods Sixty-four BPD patients and 64 medicine patients were evaluated by interviewing their parents about their childhood behavior with the Child Behavior Checklist （CBCL）. The diagnosis of ADHD was made according to the DSM-Ⅳ criteria. Results （1） Twelve BPD patients （ 19% ） would be diagnosed of ADHD in their childhood, which was significantly higher than control group （ 2 patients, 3% ; χ^2 = 8. 020, P = 0. 005 ）. （2） Four cases （25%） and 8 cases （17%） were respectively diagnosed of ADHD in their childhood in BPD patients with and without family psychotic history. The difference has no statistical significance. （3） The age of BPD onset were （ 18 ± 4） years and （ 20 ± 5 ） years, which has no statistically difference between the BPD patients with and without childhood ADHD. （4） The CBCL scores of withdraw, anxious/ depressive, thought problems, delinquent behavior, aggressive behavior, internalizing, externalizing and the total scores of behavior problem in BPD group were significantly higher than that in control group （P 〈 0. 01 ）. The scores of attention problem, aggressive behavior, externalizing and the total scores in the BPD patients with a history of childhood ADHD （ 12 cases, 19% ） were significantly higher than those without a history of childhood ADHD （52 cases, 81% ; P 〈 0.05 and P 〈 0.01 ）. Conclusions There may be a higher prevalence of childhood ADHD in bipolar disorder patients and more behavior problems before BPD onset than in controls. The BPD patients with ADHD have more attention impairment and externalizing problems in their childhood.

关 键 词：双相情感障碍 轻微脑损伤综合征 儿童行为障碍 

分 类 号：R749.4[医药卫生—神经病学与精神病学]