Course and Outcome of Bipolar Disorder in Youth - Supplement

青少年双相情感障碍的病程和结果 - 补充

• 批准号: 10397801
• 负责人: BORIS BIRMAHER
• 金额: $ 6.43万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-19 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397801
• 关键词: Adult; Age; Bipolar Disorder; Brain; Childhood; Clinical; Development; Disease; Future; Impact evaluation; Individual; Lead; Longevity; Machine Learning; Measures; Mental disorders; Mission; National Institute of Mental Health; Neurophysiology - biologic function; Outcome; Participant; Pattern; Prefrontal Cortex; Process; Psychopathology; Research Domain Criteria; Risk Factors; Sampling; Structure; Techniques; Therapeutic; Time; Youth; comorbidity; gray matter; information processing; mood symptom; neural circuit; neuroimaging; protective factors; white matter

Project Summary/Abstract - no change from original The Course and Outcome of Bipolar Disorders in Youth (COBY) study has comprehensively characterized the clinical course of a large sample of youth with bipolar disorder (BD), and has identified demographic and clinical factors that are associated with different illness courses. To date, however, COBY has not included neuroimaging assessments. Including such assessments now will allow, for the first time, an evaluation of the impact of 13-year course of BD and treatment upon neural circuitry function and structure. Furthermore, the majority of COBY participants are currently between 18-30 years old, when the brain, and prefrontal cortex in particular, continues to develop. Including neuroimaging assessments in COBY participants now can thus take advantage of the neurodevelopmental processes occurring between 18-30 years where there are unique opportunities to intervene therapeutically to help normalize abnormalities in neural functioning and structure. Focusing on this age range will also provide a critically important opportunity to determine the extent to which neuroimaging measures predict future clinical course in adulthood. Having normal prefrontal cortical function and structure may predict better clinical course in adulthood, even in COBY participants with poor clinical course in youth, and may lead to decisions to reduce, or even stop, specific treatments in these individuals. In the proposed study, we will determine how previous BD clinical course (e.g., % time with mood symptoms vs. euthymic; % time with comorbid disorders) and treatment exposure from childhood into adulthood impacts neural circuitry functioning and structure supporting key NIMH RDoC information processing domains, and compare neuroimaging findings in COBY participants with those of demographically-matched healthy controls (Aim 1). We will also determine whether neuroimaging measures predict illness course in adulthood, beyond demographic and clinical factors, and previous clinical course in youth (Aim 2). We will use machine learning to explore patterns of wholebrain functioning, white and gray matter structure, and clinical and demographic measures, that most accurately predict future clinical course at the individual subject level. The proposed study also provides a valuable opportunity to inform the field regarding the clinical and functional course and outcome from youth into adulthood in a large, well-characterized sample of people with BD. This is important because the clinical outcome of BD youth in adulthood remains uncertain, as only two studies with a total of 72 subjects followed BD youth into their early twenties. Structural and functional neuroimaging techniques will be employed in a representative subsample of COBY participants (n=120), and healthy controls (n=50). Comprehensive assessments of psychopathology and functioning will be collected at the time of neuroimaging, and twice more during the proposed project period in the 120 COBY participants. This proposal accords with the NIMH’s mission to define developmental trajectories of mental disorders and develop strategies to better define risk and protective factors for disease trajectories across the lifespan, and with the RDoC initiative.

项目摘要/摘要-与原始内容无变化 青少年双相情感障碍（COBY）研究的过程和结果全面表征了 临床过程中的一个大样本的青年双相情感障碍（BD），并确定了人口统计学和 与不同病程相关的临床因素。然而，到目前为止，COBY还没有包括 神经影像学评估。现在纳入这些评估将首次能够对 13年BD病程及治疗对神经回路功能和结构影响而且 大多数COBY参与者目前在18-30岁之间，当大脑和前额叶皮层在 特别是，继续发展。因此，包括COBY参与者的神经影像学评估， 神经发育过程的优势发生在18-30岁之间， 有机会进行治疗干预，以帮助正常化神经功能和结构的异常。 关注这一年龄段也将提供一个至关重要的机会，以确定 神经影像学测量可预测成年后的临床病程。前额皮质功能正常的 和结构可以预测更好的临床过程中，在成年期，即使在COBY参与者与穷人的临床 当然，在青年，并可能导致决定减少，甚至停止，在这些人的具体治疗。在 在拟议的研究中，我们将确定以前的BD临床过程（例如，出现情绪症状的时间百分比与 正常胸腺;患有共病的时间%）和从童年到成年的治疗暴露影响 支持关键NIMH RDoC信息处理域的神经电路功能和结构，以及 比较COBY参与者与人口统计学匹配的健康对照者的神经影像学结果 (Aim 1）。我们还将确定神经影像学指标是否能预测成年后的疾病进程， 人口统计学和临床因素，以及青年人的既往临床病程（目标2）。我们将使用机器学习 探索全脑功能模式、白色和灰质结构以及临床和人口统计学 测量，最准确地预测在个体受试者水平的未来临床过程。拟定研究 还提供了一个宝贵的机会，告知有关临床和功能过程的领域， 结果从青年到成年人在一个大的，良好的表征样本与BD的人。这很重要 因为BD青年在成年期的临床结果仍然不确定，因为只有两项研究，共72例， 受试者跟踪BD青年到20岁出头。结构和功能神经成像技术将是 在COBY参与者（n=120）和健康对照（n=50）的代表性子样本中使用。 将在神经影像学检查时收集精神病理学和功能的综合评估， 在拟议的项目期间，120名COBY参与者中有两次以上。这项建议符合 NIMH的使命是定义精神障碍的发展轨迹，并制定战略，以更好地 定义整个生命周期疾病轨迹的风险和保护因素，并与RDoC倡议。