Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

H.R.成人成套神经心理测验在我国的修订

本文是修订Halstead—Reitan成套神经心理测验(H·R·B)成人本的总结。从15个省市取样,正常组885名,脑病组350例。根据测验结果按性别和年龄制定了各分测验的划界分,按划界分计算了两组受试的损伤指数(DQ)。并制定了脑病损的诊断和定侧的标准。按此标准对样本病人进行了脑损伤的诊断和定侧。诊断符合率为80.3％,右侧病损的符合率为70.8％,左侧为45.7％。分测验的重则相关系数分别为0.93—0.39。