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: 6824216
• 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/6824216
• 关键词: adolescence (12-20); behavioral genetics; bipolar depression; child (0-11); child mental disorders; clinical research; disease /disorder onset; emotions; family genetics; functional magnetic resonance imaging; human subject; longitudinal human study; neurologic manifestations; neurophysiology; neuropsychology; pathologic process; psychophysiology

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 and neuropsychological correlates of affective dysregulation in bipolar children and adolescents. A particular focus of aim #2 is the identification of behavioral paradigms that assess psychological processes that are important in the pathophysiology of BPD, and that can be used either in subsequent fMRI studies (to identify dysfunctional neural circuitry in patients) or in family studies (to identify behavioral and biological markers of the illness i.e. endophenotypes). Approximately 26 patients and matched controls have been assessed on a battery of such paradigms. The data indicate that , compared to controls, children with BPD have deficits in 1)memory, including verbal memory (consistent with reports in adult BPD) and visual spatial memory; 2) their ability to adapt their behavior in response to changing rewards and punishments (i.e. response reversal); 3) their ability to inhibit a dominant motor response and initiate another; and 4) the ability to identify facial emotions in other children (but not adults). The latter deficit differentiates them from children with ADHD or other mood and anxiety disorders. In addition, we have developed a behavioral test in the laboratory to demonstrate that, in the context of frustration, children with BPD adopt a more impulsive response style. In addition to obtaining and analyzing these behavioral data, this year an fMRI study was begun using the motor inhibition paradigm. Finally, we continue to assess the psychiatric status of family members, bank genetic samples from patients and parents for use in future studies, and follow the patients longitudinally (clinically and with structural MRI scans) for 4 years.

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和神经心理学相关性。目标 2 的一个特别重点是确定行为范式，这些范式评估在 BPD 病理生理学中很重要的心理过程，并且可以用于后续的功能磁共振成像研究（识别患者中功能失调的神经回路）或家庭研究（识别疾病的行为和生物学标记，即内表型）。已经对大约 26 名患者和匹配的对照进行了一系列此类范例的评估。数据表明，与对照组相比，边缘性人格障碍儿童在以下方面存在缺陷：1）记忆力，包括言语记忆（与成人边缘性人格障碍的报告一致）和视觉空间记忆； 2）他们调整行为以应对不断变化的奖励和惩罚的能力（即反应逆转）； 3）他们抑制主导运动反应并启动另一个运动反应的能力； 4）识别其他儿童（但不是成人）面部情绪的能力。后者的缺陷将他们与患有多动症或其他情绪和焦虑障碍的儿童区分开来。此外，我们在实验室开发了一项行为测试，以证明在沮丧的情况下，患有边缘性人格障碍的儿童会采取更冲动的反应方式。除了获取和分析这些行为数据之外，今年还开始使用运动抑制范式进行功能磁共振成像研究。最后，我们继续评估家庭成员的精神状况，储存患者和父母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）。