Bipolar Disorder & Alcohol Abuse Comorbidity

申请人建议获得磁共振波谱学和神经内分泌学方面的新培训。这两个领域的研究将扩大他的临床研究专长，并进一步他的研究努力，试图更好地了解双相情感障碍的神经解剖学和神经内分泌学基础。研究培训将用于将这些潜在的研究成果转化为临床应用，以更好地了解并最终治疗主要的精神疾病。本研究将探讨酒精对双相情感障碍的生物化学、神经内分泌和神经心理功能的影响。双相情感障碍中酒精滥用合并症的终生患病率是所有轴I诊断中最高的;此外，双相情感障碍中酒精滥用的存在与金标准治疗碳酸锂的反应率下降有关。因此，从流行率数据和治疗反应不足来看，这是一个巨大的公共卫生问题。在横断面分析中，双相情感障碍和共病酒精滥用或依赖患者、无共病酒精滥用或依赖的双相情感障碍患者和年龄匹配的健康对照者将接受1H-MR波谱、地塞米松/CRH神经内分泌激发和神经心理学评价，评估执行功能、言语记忆和工作记忆。本研究将评估三组之间是否存在差异，以及N-乙酰天冬氨酸（NAA）、下丘脑-垂体-肾上腺轴功能和神经心理功能之间是否存在关系。还将评价这些变量在自然随访下复发的预测潜力，其中将监测情绪稳定性、酒精渴望和复发、药物依从性和功能能力。 这种自然的随访期可能会发现与复发相关的初步神经生物学因素，并为进一步的对照干预研究提供方向。

The applicant proposes to acquire new training in magnetic resonance spectroscopy and neuroendocrinology. These two areas of investigation will expand his clinical research expertise and further his research endeavors in attempting to better understand the neuroanatomic and neuroendocrinological underpinnings of bipolar disorder. The research training will then be used to translate these potential research gains into clinical applications to better understand and ultimately treat major psychiatric illnesses. This study will examine the impact of alcohol on the biochemistry, neuroendocrinology, and neuropsychological functioning of bipolar illness. The lifetime prevalence rate of alcohol abuse comorbidity in bipolar disorder is the highest of all Axis I diagnoses; furthermore, the presence of alcohol abuse in bipolar disorder is associated with a decreased response rate to the gold standard treatment lithium carbonate. Thus, by prevalence data and inadequate treatment response, this represents an enormous public health problem. In a cross-sectional analysis, patients with bipolar disorder and comorbid alcohol abuse or dependence, patients with bipolar illness without comorbid alcohol abuse or dependence, and age matched healthy controls will undergo 1 H-MR spectroscopy, Dexamethasone/CRH neuroendocrine challenge, and neuropsychological evaluation assessing executive function, verbal memory, and working memory. This study will evaluate whether there are differences amongst the three groups and if there is a relationship between N-acetylaspartate (NAA), hypothalamic-pituitary adrenal axis function, and neuropsychological functioning. These variables will also be evaluated as to their predictive potential for relapse under naturalistic follow-up where mood stability, alcohol craving and relapse, medication compliance, and functional capacity will be monitored. This naturalistic follow-up period may identify preliminary neurobiological factors associated with relapse and provide direction for further controlled interventional study.