The Phenomenology And Neurophysiology Of Juvenile Bipola

这项研究有两个特别的目的：1)使用纵向的、客观的技术来描述早发性双相情感障碍(BPD)的临床表现；2)确定双相儿童和青少年情感调节障碍的神经生理学相关性。为了实现具体的目标1，我们将获得前瞻性的临床数据(包括日常情绪和行为评分和动作图数据)和直接的观察数据，并进行神经心理评估。为了实现特定的目标#2，我们将使用标准化的情绪刺激来检验这一假设，即BPD儿童对负面情绪刺激的反应比对照组更明显。此外，我们将评估患者家属的精神状态，保存患者和一级亲属的基因样本，以供未来研究使用，并对患者进行纵向跟踪(临床和结构磁共振扫描)4年。100名儿童已被筛选纳入这项研究，其中20名已被接受。虽然所有接受筛查的患者都在社区接受BPD治疗，但只有那些符合严格的DSM-IV疾病标准的患者才被纳入研究，其中包括发作(即“狭义表型”)。“接受”组和“排除”组的比较表明，接受接受的患者更有可能有BPD的父母病史；终生自杀未遂和精神病史；以及表现出躁狂的显著症状(例如，兴高采烈，浮夸，睡眠需求减少，目标导向活动增加)。来自接受研究的儿童及其父母的动作记录仪和每日情绪评级数据表明，父母报告的与躁狂日一致的行为与运动活动增加有关。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，并容易将面孔(特别是同龄人的面孔)误认为是愤怒的。

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.