The Phenomenology And Neurophysiology Of Juvenile Bipola

本研究有两个具体目的：1)使用纵向、客观的技术来表征早发性双相情感障碍（BPD）的临床表现；2)确定双相情感障碍儿童和青少年的神经生理相关因素。为了实现Specific Aim #1，我们将获得前瞻性临床数据（包括日常情绪和行为评分以及活动记录数据）和直接观察数据，并进行神经心理学评估。为了实现特定目标#2，我们将使用标准化的情绪刺激来验证BPD儿童对负面情绪刺激的反应比对照组更明显的假设。此外，我们将评估家庭成员的精神状态，从患者和一级亲属中提取基因样本用于未来的研究，并对患者进行为期4年的纵向随访（临床和结构MRI扫描）。已经筛选了100名儿童纳入研究，其中20名已被接受。虽然所有被筛选的患者都在社区接受BPD治疗，但只有那些符合DSM-IV严格的疾病标准的患者，包括发作性（即精神分裂症）。“窄表现型”)，都被接受进入研究。“接受”组和“排除”组的比较表明，接受的患者更有可能有父母的BPD病史；有自杀企图和精神病史；并表现出躁狂的标志性症状（如兴高采烈、浮夸、睡眠需求减少、目标导向活动增加）。参与研究的儿童及其父母的活动记录仪和每日情绪评级数据表明，父母报告的躁狂日的行为与运动活动的增加有关。初步的神经心理学数据表明可能存在记忆缺陷，包括言语记忆（与成人BPD的报告一致）、视觉空间记忆和工作记忆。最后，行为数据表明，与对照组相比，双相儿童在运动抑制任务上延迟，并且容易将面孔（尤其是同伴的面孔）误认为愤怒。

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 correlates of affective dysregulation in bipolar children and adolescents. To accomplish Specific Aim #1, we will obtain prospective clinical data (including daily mood and behavioral ratings and actigraphy data) and direct observational data, and perform neuropsychological assessments. To accomplish Specific Aim #2, we will use standardized emotional stimuli to test the hypothesis that responses to negative emotional stimuli are more pronounced in children with BPD than in controls. In addition, we will assess the psychiatric status of family members, bank genetic samples from patients and first-degree relatives for use in future studies, and follow the patients longitudinally (clinically and with structural MRI scans) for 4 years. One hundred children have been screened for inclusion in the study, and twenty have been accepted. While all of the screened patients are receiving treatment in the community for BPD, only those who meet strict DSM-IV criteria for the illness, including episodicity(i.e. the "narrow phenotype"), are accepted into the study. Comparison of the "accepted" and "ruled-out" groups indicate that the accepted patients are more likely to have a parental history of BPD; lifetime history of suicide attempts and psychosis; and to exhibit hallmark symptoms of mania (e.g. elation, grandiosity, decreased need for sleep, increased goal-directed activity). Actigraphy and daily mood rating data from children accepted into the study and their parents indicate that parent report of behaviors consistent with a manic day is associated with increased motor activity. Preliminary neuropsychological data indicate possible memory deficits, including verbal memory (consistent with reports in adult BPD), visual spatial memory, and working memory. Finally, behavioral data indicate that, compared to control subjects, bipolar children are delayed on motor inhibition tasks, and were prone to misidentify faces (especially those of peers) as angry.