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和神经心理相关因素。目标#2的一个特别重点是识别行为范式，这些行为范式可以评估在BPD病理生理学中重要的心理过程，并且可以用于后续的fMRI研究（识别患者的功能失调神经回路）或家庭研究（识别疾病的行为和生物学标记，即内表型）。大约26名患者和匹配的对照者已经在一系列这样的范例上进行了评估。数据表明，与对照组相比，患有BPD的儿童在1)记忆方面存在缺陷，包括言语记忆（与成人BPD报告一致）和视觉空间记忆；2)根据奖惩变化调整行为的能力（即反应逆转）；3)抑制显性运动反应并启动另一显性运动反应的能力；4)识别其他儿童（但不是成人）面部情绪的能力。后一种缺陷将他们与患有多动症或其他情绪和焦虑障碍的儿童区分开来。此外，我们在实验室开发了一种行为测试来证明，在沮丧的情况下，BPD儿童采取了更冲动的反应方式。除了获取和分析这些行为数据外，今年开始了一项使用运动抑制范式的功能磁共振成像研究。最后，我们继续评估家庭成员的精神状态，从患者和父母那里收集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）。

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 and neuropsychological correlates of affective dysregulation in bipolar children and adolescents. A particular focus of aim #2 is the identification of behavioral paradigms that assess psychological processes that are important in the pathophysiology of BPD, and that can be used either in subsequent fMRI studies (to identify dysfunctional neural circuitry in patients) or in family studies (to identify behavioral and biological markers of the illness i.e. endophenotypes). Approximately 26 patients and matched controls have been assessed on a battery of such paradigms. The data indicate that , compared to controls, children with BPD have deficits in 1)memory, including verbal memory (consistent with reports in adult BPD) and visual spatial memory; 2) their ability to adapt their behavior in response to changing rewards and punishments (i.e. response reversal); 3) their ability to inhibit a dominant motor response and initiate another; and 4) the ability to identify facial emotions in other children (but not adults). The latter deficit differentiates them from children with ADHD or other mood and anxiety disorders. In addition, we have developed a behavioral test in the laboratory to demonstrate that, in the context of frustration, children with BPD adopt a more impulsive response style. In addition to obtaining and analyzing these behavioral data, this year an fMRI study was begun using the motor inhibition paradigm. Finally, we continue to assess the psychiatric status of family members, bank genetic samples from patients and parents for use in future studies, and follow the patients longitudinally (clinically and with structural MRI scans) for 4 years.