Differentiating Unipolar and Bipolar Depression in Young Adults Using fMRI

使用功能磁共振成像区分年轻人的单相和双相抑郁症

• 批准号: 8603951
• 负责人: Amit Anand
• 金额: $ 51.07万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-05 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8603951
• 关键词: Differentiating; Unipolar; Bipolar; Depression; Young

ABSTRACT One of the great unsolved mysteries regarding neurobiology of mood disorders is - why do some patients suffer only from episodes of depression (unipolar depression or UD, also known as major depression) while others suffer from episodes of both depression and the opposite mood state of mania (bipolar disorder or BD). In the clinical setting, both UD and BD depression (BDD) are difficult to differentiate and can only be teased apart by obtaining a detailed longitudinal history to identify periods of (hypo)mania. However, in young patients, early in the course of the illness, this history is either very difficult to elicit or not present because the first few episodes of BD are usually of depression. Only with time, and usually after years of misdiagnosis and inappropriate treatment, a proportion of the depressed subjects start suffering from episodes of overt (hypo)mania and reveal themselves to be actually suffering from BD. Therefore, there is a critical need to identify, particularly in young patients, neurobiological differences between BDD and UD as well as differences between UD patients at a high risk for developing BD (HRUD) and UD patients with low risk of developing BD (LRUD). The investigators have been conducting functional magnetic resonance imaging (fMRI) studies of corticolimbic connectivity and activity for nearly a decade and in recent studies have identified resting state connectivity abnormalities as well as task-induced activation abnormalities in BD and UD. Preliminary data suggests that these measures may be helpful in differentiating between BDD and UD. This proposal will investigate corticoamygdalar connectivity and activation abnormalities in 40 BDD, 80 UD (40 HRUD and 40 LRUD) young adult patients (21 - 35 yrs of age) compared to 40 matched healthy controls (HC). Besides investigating cross-sectional differences between groups, an exploratory prospective validation of the BDD related abnormalities would also be conducted by treating the 80 UD subjects with antidepressants for 6 months and then following them up naturalistically for another 18 months. Subjects will be assessed frequently for emergence of (hypo)mania to be identified as converters to a BD diagnosis. Differences between converters and non-converters on the imaging measures will be investigated and an analysis will be conducted whether the imaging measures correlate with risk of conversion over time. Innovative aspects of this proposal are: it addresses the understudied area of differences between unmedicated BDD and UD patients using fMRI measures to study circuit level abnormalities; studies young adults in which the issue is most important; investigates (in line with aims of the new NIMH Research Domain Criteria (RDoC) project) the similarities between HRUD and BDD subjects; and uses a cross-sectional as well as prospective study design to explore the power of the imaging measures to predict the risk of conversion from UD to BD diagnosis. Findings from this study will have a critical impact both on the understanding of the neurobiology of mood disorders as well as on the difficult clinical issue of how to differentiate between BDD and UD patients in young adults.

抽象的 关于情绪障碍神经生物学的尚未解决的谜团之一是 - 为什么有些患者 仅患抑郁症发作（单极抑郁或UD，也称为大抑郁症），而 其他人则遭受抑郁症和相反情绪躁狂状态（双相情感障碍或BD）的情绪。 在临床环境中，UD和BD抑郁症（BDD）都难以区分，只能嘲笑 除了获得详细的纵向历史以识别（降低）躁狂时期。但是，年轻 患者，在疾病的早期，这段历史要么很难引起，要么不存在，因为 BD的前几集通常是抑郁症。只有时间，通常是经过多年的误诊和 不适当的待遇，一部分沮丧的受试者开始遭受明显的发作 （Hypo）躁狂症，并露出自己实际上患有BD。因此，迫切需要 识别，特别是在年轻患者中，BDD和UD之间的神经生物学差异以及差异 在患有BD的高风险的UD患者（HRUD）和患有BD风险较低的UD患者之间 （lrud）。研究人员一直在进行对功能磁共振成像（fMRI）研究 近十年来的皮质脂质连通性和活性已经确定了静止状态 连通性异常以及任务诱导的BD和UD激活异常。初步数据 表明这些措施可能有助于区分BDD和UD。该提议将 研究40 bdd的皮质型和激活异常（40 hrud和40） LRUD）年轻人患者（21-35岁），而40例匹配的健康对照（HC）。除了 研究组之间的横截面差异，这是对BDD的探索性前瞻性验证 相关异常也将通过用抗抑郁药治疗80受试者进行6 几个月，然后自然而然地关注他们，再过18个月。受试者将经常评估 为了出现（降低）躁狂症，可以识别为BD诊断的转换器。之间的差异 将研究成像措施上的转换器和非转换器，并将进行分析 成像是否与随着时间的推移的转化风险相关。该提议的创新方面 是：它解决了使用fMRI的未经监测的BDD和UD患者之间差异的研究领域 研究电路水平异常的措施；研究这个问题最重要的年轻人； 调查（根据新的NIMH研究领域标准（RDOC）项目的目标）相似之处 在Hrud和BDD主题之间；并使用横截面和前瞻性研究设计探索 成像措施的力量可以预测从UD到BD诊断的转化风险。来自 这项研究也将对对情绪障碍神经生物学的理解产生关键的影响 就像如何区分年轻人的BDD和UD患者的困难临床问题一样。