Bipolar Disorder Across the Life Span

描述(由申请人提供)：双相情感障碍(BPD)影响着至少230万18岁及以上的美国成年人(占美国人口的1.2%)，在5-9%有严重情绪障碍的儿童中，BPD的患病率尚不清楚。1990年，在成熟的市场经济中，BPD导致170万年因过早死亡或残疾而失去健康生命，仅次于严重抑郁症和精神分裂症。约15%的BPD患者自杀。NIMH用于支持BPD研究的资金比例低于NIMH领导层的预期，而且没有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，致力于全生命周期的BPD研究。拟建的中心针对1999年《桥接科学和服务》报告中的许多建议，将重点放在从5岁到生命末期的BPD患者复杂的共病群体中使用新的纵向研究设计，以及关注功能和残疾，而不仅仅是症状改善。该中心的科学主题将是进行研究，旨在“改善BPD服务不足人群的临床结果，包括那些在社区精神卫生中心(CMHC)接受护理的人，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，以提高在CMHC中患有BPD的166名成人患者的治疗依从性；2)一项单中心儿童服务项目，旨在提高在CMHC评估的615名儿童和青少年对BPD的早期和准确认识；以及3)为期6个月的两个中心、双盲、平行分组的两种联合治疗方案(锂/异丙孕酮/拉莫三嗪与锂/异丙孕酮/安慰剂)用于90名患有快速循环bpd的成人患者的急性和持续门诊管理。和/或凯斯西储大学/克利夫兰大学医院和CMHC的可卡因滥用/依赖。这一应用程序将用于建立和维护一个网站网络，以进行临床试验研究，同时解决BPD在整个生命周期中的有效性和有效性问题。这个开发中心的申请将用于与社区环境发展研究伙伴关系，并发展持续的关系，并打算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.