Early Assessment and Intervention for Adolescents at Risk for Bipolar Disorder

对有双相情感障碍风险的青少年进行早期评估和干预

• 批准号: 8113588
• 负责人: TINA R GOLDSTEIN
• 金额: $ 22.73万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-18 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8113588
• 关键词: Address; Adolescence; Adolescent; Adult; Aftercare; Age; Age of Onset; Area; Biological; Bipolar Disorder; Child; Chronic; Chronic Disease; Circadian Rhythms; Data; Development; Disease; Distal; Early treatment; Family member; Feedback; Future; Goals; Health Care Costs; Impairment; Individual; Intake; Intervention; Manic; Measurable; Measures; Mental Health Services; Mental disorders; Methods; Modeling; Mood Disorders; Moods; National Institute of Mental Health; Occupational; Onset of illness; Outcome; Parents; Participant; Patients; Pattern; Population; Psychopathology; Public Health; Randomized; Recurrence; Research; Risk; Risk Factors; Services; Sleep; Sleep Disorders; Sleep Wake Cycle; Sleep disturbances; Strategic Planning; Symptoms; Testing; Time; Treatment Efficacy; Work; Youth; control trial; cost effective; depressive symptoms; design; early experience; early onset; experience; high risk; improved; innovation; malleable risk; modifiable risk; offspring; prevent; randomized trial; sleep regulation; social; suicide rate

DESCRIPTION (provided by applicant): The most potent risk factor for the development of bipolar disorder (BP) is a first-degree family member with the illness. Thus, offspring of parents with BP are a particularly high-risk group and typically experience early illness onset, severe course, and high rates of comorbid psychiatric disorders. It is well-established that poor sleep regulation is associated with the onset of depressive and manic episodes among individuals with a biological vulnerability to mood disorder. Furthermore, evidence supports sleep disturbance in at-risk youth who have not yet developed threshold mood disorders. The proposed study aims to address this core disturbance that we argue puts at-risk youth at even greater risk for development of BP-sleep and social rhythm disruption. Since adolescence is a period characterized by significant alterations in sleep/wake patterns and social routines, this period may prove optimal for assessment and treatment of sleep and psychiatric symptoms in those at-risk. We adapted and piloted Interpersonal and Social Rhythm Therapy (IPSRT), an empirically-supported treatment for adults with BP that helps patients stabilize sleep/wake cycles and daily routines, for at-risk adolescents. Preliminary data indicate this approach holds promise as for youth at-risk for the development of BP. We also identified intervention for the heterogeneous conditions antecedent to BP as a second path to preventing or delaying BP onset in at-risk youth. The purpose of the proposed study is thus to further develop and examine IPSRT for the adolescent (age 12-18) offspring of parents with BP. The study involves conduct of a small controlled trial (n=50) comparing Brief IPSRT + Data-Informed Referral versus Data-Informed Referral alone to gather preliminary data on feasibility, acceptability and proximal outcomes associated with the intervention. All participants receive a thorough assessment of psychopathology and sleep disturbance (via objective and subjective methods) at baseline, followed by a single feedback session reviewing the findings. As clinically indicated, youth will be offered Data-Informed Referral for any psychiatric symptoms/disorders identified during the intake assessment. Youth will then be randomized to receive either Brief IPSRT or no Brief IPSRT; randomization will be stratified on sleep disturbance and psychopathology. Outcomes will be assessed at 4 time points over 6 months in all participants. Data will be used to inform the design and conduct of a future controlled trial. The proposed approach is in direct accord with strategies outlined in the NIMH Strategic Plan in which the development and testing of innovative interventions to reduce risk and positively alter trajectories of mental illness are informed by research findings regarding robust and malleable risk factors and core features of disease. Research in this area is of great public health importance, as it has the potential to prevent, delay, or ameliorate the progression of this chronic and devastating illness in those at highest risk. PUBLIC HEALTH RELEVANCE: Bipolar disorder is a severe and chronic illness associated with significant occupational and social impairment, enormous public health costs, and high rates of suicide. The single most potent risk factor for the development of bipolar disorder is a first-degree family member with the illness; indeed, offspring of parents with bipolar disorder are a particularly high-risk group who typically display early onset and severe course of illness. Thus, early assessment and intervention for the children of parents with bipolar disorder focused on specific, measurable, and modifiable risk factors has the potential to prevent or ameliorate the progression of bipolar disorder in those at highest risk.

描述（由申请人提供）：躁郁症发展（BP）的最有效的风险因素是患有该疾病的一级家庭成员。因此，BP的父母的后代是一个特别高风险的人群，通常会出现早期疾病发作，严重的病程和合并症的精神疾病率高。良好的睡眠调节与具有情绪障碍的生物学脆弱性的个体之间的抑郁和躁狂发作的发作有关。此外，证据支持尚未患上阈值情绪障碍的高危青年的睡眠障碍。拟议的研究旨在解决这种核心骚扰，我们认为，高危青年面临BP-睡觉和社会节奏破坏的更大风险。由于青春期是一个以睡眠/唤醒模式和社会习惯发生重大改变的时期，因此这一时期可能证明是对那些处于危险中的睡眠和精神症状的评估和治疗的最佳选择。我们改编并试用的人际交往和社会节奏治疗（IPSRT），这是一种经验支持BP的成年人的经验治疗，可帮助患者稳定睡眠/唤醒周期和日常习惯，以供处于危险中的青少年。初步数据表明，这种方法对BP的发展有希望。我们还确定了对BP的异质条件的干预措施，这是防止或延迟处于危险的青年中BP发作的第二道路。因此，拟议的研究的目的是为BP的父母的青少年（12-18岁）后代进一步发展和检查IPSRT。该研究涉及进行小型对照试验（n = 50），以比较简短的IPSRT +数据信息转介与单独的数据信息转介，以收集有关可行性，可接受性和与干预相关的近端结果的初步数据。所有参与者在基线时都会对心理病理学和睡眠障碍（通过客观和主观方法）进行彻底评估，然后进行一次反馈会议，以审查调查结果。如临床上所示，将为摄入量评估期间发现的任何精神症状/疾病提供数据信息转介。然后，年轻人将被随机收到简短的IPSRT或没有简短的IPSRT；随机化将根据睡眠障碍和心理病理学进行分层。在所有参与者中，将在6个月内在4个时间点评估结果。数据将用于告知未来对照试验的设计和行为。拟议的方法直接与NIMH战略计划中概述的策略一致，在该计划中，有关强大和可延展的风险因素以及疾病的核心特征的研究结果，可以为降低风险和积极改变精神疾病的创新干预措施的开发和测试。在这一领域的研究非常重要，因为它有可能预防，延迟或改善这种慢性和毁灭性疾病的进展。 公共卫生相关性：躁郁症是一种严重而慢性疾病，与重大职业和社会障碍，巨大的公共卫生成本以及高自杀率有关。躁郁症发展的最有效的危险因素是患有该疾病的一级家庭成员。确实，躁郁症父母的后代是一个特别高风险的群体，他们通常表现出早期发作和严重的疾病。因此，针对双相情感障碍父母的孩子的早期评估和干预集中在特定，可测量和可修改的危险因素上，有可能预防或改善风险最高的躁郁症的进展。