The Phenomenology And Neurophysiology Of Juvenile Bipola

青少年双相情感障碍的现象学和神经生理学

• 批准号: 6671653
• 负责人: Ellen Leibenluft
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6671653
• 关键词: adolescence (12-20); behavioral genetics; bipolar depression; child (0-11); child mental disorders; clinical research; disease /disorder onset; emotions; family genetics; human subject; longitudinal human study; magnetic resonance imaging; neurologic manifestations; neurophysiology; pathologic process

This study has two specific aims: 1) to use longitudinal, objective techniques to characterize the clinical manifestations of early-onset bipolar disorder (BPD); and 2) to identify neurophysiological correlates of affective dysregulation in bipolar children and adolescents. To accomplish Specific Aim #1, we will obtain prospective clinical data (including daily mood and behavioral ratings and actigraphy data) and direct observational data, and perform neuropsychological assessments. To accomplish Specific Aim #2, we will use standardized emotional stimuli to test the hypothesis that responses to negative emotional stimuli are more pronounced in children with BPD than in controls. In addition, we will assess the psychiatric status of family members, bank genetic samples from patients and first-degree relatives for use in future studies, and follow the patients longitudinally (clinically and with structural MRI scans) for 4 years. One hundred children have been screened for inclusion in the study, and twenty have been accepted. While all of the screened patients are receiving treatment in the community for BPD, only those who meet strict DSM-IV criteria for the illness, including episodicity(i.e. the "narrow phenotype"), are accepted into the study. Comparison of the "accepted" and "ruled-out" groups indicate that the accepted patients are more likely to have a parental history of BPD; lifetime history of suicide attempts and psychosis; and to exhibit hallmark symptoms of mania (e.g. elation, grandiosity, decreased need for sleep, increased goal-directed activity). Actigraphy and daily mood rating data from children accepted into the study and their parents indicate that parent report of behaviors consistent with a manic day is associated with increased motor activity. Preliminary neuropsychological data indicate possible memory deficits, including verbal memory (consistent with reports in adult BPD), visual spatial memory, and working memory. Finally, behavioral data indicate that, compared to control subjects, bipolar children are delayed on motor inhibition tasks, and were prone to misidentify faces (especially those of peers) as angry.

本研究有两个具体目标：1）使用纵向、客观的技术来表征早发双相情感障碍（BPD）的临床表现； 2）确定双相情感障碍儿童和青少年情感失调的神经生理学相关性。为了实现具体目标#1，我们将获得前瞻性临床数据（包括日常情绪和行为评级以及体动记录数据）和直接观察数据，并进行神经心理学评估。为了实现具体目标#2，我们将使用标准化的情绪刺激来检验这样的假设：边缘性人格障碍儿童对负面情绪刺激的反应比对照组更明显。此外，我们将评估家庭成员的精神状况，储存患者和一级亲属的基因样本以供未来研究使用，并对患者进行为期 4 年的纵向跟踪（临床和结构 MRI 扫描）。一百名儿童经过筛选被纳入这项研究，其中二十名已被接受。虽然所有经过筛选的患者都在社区接受 BPD 治疗，但只有那些符合严格的 DSM-IV 标准（包括发作性（即“狭义表型”））的患者才能被纳入研究。比较“接受”组和“排除”组表明，接受的患者更有可能有BPD父母史；终生自杀未遂和精神病史；并表现出躁狂症的标志性症状（例如兴高采烈、自大、睡眠需求减少、目标导向活动增加）。接受研究的儿童及其父母的体动记录仪和每日情绪评级数据表明，父母报告的与躁狂日一致的行为与运动活动的增加有关。初步神经心理学数据表明可能存在记忆缺陷，包括言语记忆（与成人 BPD 的报告一致）、视觉空间记忆和工作记忆。最后，行为数据表明，与对照组相比，躁郁症儿童在运动抑制任务上延迟，并且容易将面孔（尤其是同龄人的面孔）误认为是生气。