OBSTETRIC COMPLICATIONS AND PATHOLOGY IN BIPOLAR ILLNESS

描述(申请人摘要)：这项资助的长期目标 是促进对产科并发症的病因作用的理解 (OCS)，及其与脑和神经心理异常的关系 双相情感障碍。如果OCS确实具有重要的病因学意义，它可能 具有重要的健康影响，因为最佳产科护理的目标是 然后，双相情感障碍的高危个体将提供一个有吸引力的 初级预防该疾病的方法。具体目标是 调查是否有可能(A)不仅复制最近的研究 双相情感障碍患者OCS显著过量的发现， 与正常对照组或患者自己的兄弟姐妹相比，但也 (B)率先调查在双相情感障碍患者中，OCS是否可能 与MRI(磁共振成像)上看到的脑部异常有关 扫描和神经心理测试表现不佳。 研究设计和方法包括获得出生和出生的OC数据 (A)40名首次入院的双相情感障碍先证者的妊娠情况 年龄18-50岁和(B)40名精神正常对照先证者 年龄、性别、族裔和惯用手，以及(C)大约120个 躁郁症先证者和对照先证者的兄弟姐妹。诊断将使用 DSM-IV标准，基于结构化诊断访谈(SCID)， 并辅之以图表回顾。汇总OC分数将通过以下方式获得 将公布的评级标准应用于OC数据，这些数据来自与 受试者的母亲。OC、诊断、MRI和神经心理学评估 将会盲目地相互尊重。建议的研究是 极具成本效益，因为它将把OC数据的收集“搭载”到 已经资助的更大规模的研究，用于收集诊断、核磁共振和 躁郁症先证者和对照先证者的神经心理测试数据。统计数据 适用于获得的OC数据分布将用于测试 双相先证者的OC分数高于(或差于)的假设 要么是正常对照，要么是躁郁症先证者的兄弟姐妹 较高的OC分数将与(A)脑结构异常相关 在MRI扫描和(B)较差的神经心理测试中观察到 性能。

DESCRIPTION (Applicant's abstract): The long-term objective of this grant is to advance understanding of the etiologic role of obstetric complications (OCs), and their relation to brain and neuropsychological abnormalities in bipolar disorder. If OCs are indeed etiologically significant, it could have important health implications, as optimal obstetric care targeted on individuals at high risk for bipolar disorder would then offer an attractive approach to primary prevention of the disorder. The specific aims are to investigate whether it is possible (a) not only to replicate recent study findings of a significant excess of OCs in patients with bipolar disorder, compared with either normal controls or the patients' own siblings, but also (b) to pioneer investigation of whether, in bipolar patients, OCs may be associated with brain abnormalities seen on MRI (magnetic resonance imaging) scans and with poor performance on neuropsychological tests. The research design and methods involve obtaining OC data on the births and pregnancies of (a) 40 first-admission patient probands with bipolar disorder aged 18-50 and (b) 40 psychiatrically normal control probands similar in age, gender, ethnicity, and handedness, along with (c) approximately 120 of the bipolar and control probands' respective siblings. Diagnoses will use DSM-IV criteria, based on structured diagnostic interviews (SCID), supplemented by chart review. Summary OC scores will be obtained by applying published rating scales to OC data obtained from interviews with subjects' mothers. OC, diagnostic, MRI, and neuropsychological assessments will be made blindly with respect to each other. The proposed study is highly cost-effective, as it will "piggyback" collection of OC data onto a larger study already funded to collect diagnostic, MRI and neuropsychological test data on bipolar and control probands. Statistics appropriate to obtained OC data distributions will be used to test the hypotheses that bipolar probands have higher (i.e., worse) OC scores than either normal controls or the bipolar probands' own siblings, and that higher OC scores will be associated (a) with structural brain abnormalities observed on MRI scans and (b) with poorer neuropsychological test performance.