Bipolar Disorder Across the Life Span

描述（申请人提供）：双相情感障碍（BPD）影响至少230万18岁及以上的美国成年人（1.2%的美国人口）和5-9%的儿童有严重的情绪障碍，BPD的患病率是未知的，在1990年，BPD在成熟的市场经济中导致170万年的健康寿命损失，由于过早死亡或残疾，仅次于抑郁症和精神分裂症大约15%的BPD患者会自杀。NIMH用于支持BPD研究的资金比例低于NIMH领导层的预期，并且没有NIMH资助的BPD研究中心。这些数据表明，迫切需要一个NIMH研究中心，致力于整个生命周期的BPD研究。拟议的中心解决了1999年“桥接科学与服务”报告中的许多建议，重点是利用新的纵向研究设计，在复杂的共病组患者的BPD从5岁到生命的尽头，以及通过关注功能和残疾，而不仅仅是症状的改善。该中心的科学主题将是开展旨在“改善服务不足的BPD人群的临床结果”的研究，包括在社区精神卫生中心（CMHC）接受治疗的人群、儿童和青少年以及目前滥用酒精和/或药物的成年人。试点项目包括：1）一项单中心心理社会干预研究，旨在开发一种有效和实用的方法，改善CMHC中166名BPD成人的治疗依从性，2）一项单中心儿童服务项目，旨在改善CMHC中评估的615名儿童和青少年对BPD的早期和准确识别，以及3）一项为期6个月的双中心双盲，在Case Western Reserve University/University Hospitals of Cleveland和CMHC对90例伴有酒精、大麻和/或可卡因滥用/依赖的快速循环BPD成人患者进行急性和持续门诊管理的两种联合治疗方案（锂/双丙戊酸钠/拉莫三嗪vs锂/双丙戊酸钠/安慰剂）的平行组比较。此应用程序将用于构建和维护一个研究中心网络，以进行临床试验研究，同时解决整个生命周期中BPD的疗效和有效性问题。此开发中心应用程序将用于与社区环境建立研究伙伴关系并发展持续的关系，并旨在在五年内提交高级中心。

DESCRIPTION (provided by applicant): Bipolar disorder (BPD) affects a minimum of 2.3 million American adults aged 18 and older (1.2% of US population) and in the 5-9% of children with serious emotional disturbances, the prevalence of BPD is unknown, in 1990, BPD in established market economies resulted in 1.7 million years of lost healthy life due to premature death or disability, third only to major depression and schizophrenia. About 15% of patients with BPD commit suicide. The proportion of the NIMH dollar that goes to support research in BPD is less than expected by NIMH leadership, and there are no NIMH-funded BPD research centers. These data suggest there exists an urgent need for an NIMH research center dedicated to BPD research across the life cycle. The proposed Center addresses many of the recommendations in the 1999 "Bridging Science and Services" report by focusing on the utilization of novel longitudinal study designs in complex comorbid groups of patients with BPD from ages 5 through the end of life, as well as by focusing on function and disability, not just symptom improvement. The scientific theme of this Center will be conduct of studies designed to "improve clinical outcomes in underserved population of BPD, including those receiving care within community mental health centers (CMHC), children and adolescents, and adults currently abusing alcohol and/or drugs. The pilot projects include: 1) a single-center psychosocial intervention study designed to develop an efficient and practical way of improving treatment adherence in 166 adults with BPD in a CMHC, 2) a single-center child services project intended to improve the early and accurate recognition of BPD in 615 children and adolescents evaluated at a CMHC, and 3) a six-month, two-center, double-blind, parallel-group comparison of two regimens of combination therapy (lithium/divalproex/lamotrigine versus lithium/divalproex/placebo) for the acute and continuation outpatient management of 90 adult patients with rapid cycling BPD comorbid with alcohol, cannabis, and/or cocaine abuse/dependence at Case Western Reserve University/University Hospitals of Cleveland and a CMHC. This application will be used to build and maintain a network of sites to conduct clinical trials research that concurrently addresses issues of efficacy and effectiveness in BPD across the life cycle. This Developing Center application will be used to develop research partnerships with community settings and grow ongoing relationships, and is intended to lead to an Advanced Center submission in five years.