The Characterization And Treatment Of Children With Seve

最近，研究人员和临床医生将越来越多的注意力集中在一群有严重情绪和行为障碍的儿童身上。这些儿童的特点是损害症状，包括基线情绪异常(即易怒、愤怒和/或悲伤)、高度觉醒(例如失眠、烦躁、注意力不集中)，以及对负面情绪刺激的反应增加。由于这种综合征与双相情感障碍(BPD)有许多共同的临床特征，对于这些儿童是否应该被诊断为双相情感障碍，有相当大的争论。然而，患有这种综合征的儿童缺乏BPD的主要症状，以及其他DSM-IV诊断(ADHD、ODD等)。捕获不同的临床人群，包括许多没有出现上述症状的儿童。因此，该项目的目标是1)可靠地识别一组患有严重情绪和行为障碍的儿童，以便对他们进行临床特征描述和纵向跟踪；2)在这一人群中进行锂的双盲、安慰剂对照试验；以及3)调查锂的反应是否在这一组患者中也有类似的效果，锂反应与神经营养效应和磷脂酰肌醇信号的变化有关。将使用标准化的访谈模块和评定量表对情绪调节障碍的临床特征进行评分。将进行锂的双盲、安慰剂对照试验，并在治疗前后进行磁共振波谱(MRS)测量NAA和MI。大约10名患者已经完成了治疗试验，并进行了MRS扫描。此外，MRS扫描和神经心理测试数据正在从对照成人和儿童的样本中获得，以使我们能够建立神经化学的发育标准，并探索NAA水平和前额叶皮质功能测试之间的联系。最后，与国家儿童医学中心建立了合作关系，以便使我们能够在三级保健儿童精神科诊所的环境中应用标准化工具，以确定患有严重情绪障碍的儿童的特征。

Recently, researchers and clinicians have focused increased attention on a group of children with severe mood and behavioral dysregulation. These children are characterized by impairing symptoms that include abnormal baseline mood (i.e. irritability, anger, and/or sadness), hyperarousal (e.g. insomnia, agitation, distractibility), and increased reactivity to negative emotional stimuli. Because this syndrome shares many clinical features with bipolar disorder (BPD), there is considerable debate as to whether these children should be diagnosed with BPD. However, children with this syndrome lack the cardinal symptoms of BPD, and other DSM-IV diagnoses (ADHD, ODD, etc.) capture heterogeneous clinical populations that include many children who do not exhibit the symptoms noted above. Therefore, the goals of this project are 1) to identify reliably a group of children with severe mood and behavioral dysregulation in order to characterize them clinically and follow them longitudinally; 2) to conduct a double-blinded, placebo-controlled trial of lithium in this population; and 3) investigate whether lithium response, which has been associated with neurotrophic effects and with changes in phosphoinositide signaling in bipolar patients, has similar effects in this group of patients. Standardized interview modules and rating scales will be used to rate the clinical features of mood dysregulation. A double-blind, placebo-controlled trial of lithium will be conducted, and magnetic resonance spectroscopy (MRS) to measure NAA and mI will be preformed before and after treatment. Approximately 10 patients have completed the treatment trial, and MRS scans have been obtained. In addition, MRS scans and neuropsychological test data are being acquired from a sample of control adults and children to allow us to establish developmental norms for neurochemistry, and to explore associations between NAA levels and tests of prefrontal cortical function. Finally, a collaboration with Children's National Medical Center has been established in order to allow us to apply, in the setting of a tertiary care child psychiatric clinic, standardized instruments designed to characterize children with severe mood dysregulation.