Children: Mood Dysregulation Characterization/Treatment

儿童：情绪失调特征/治疗

• 批准号: 6982701
• 负责人: Ellen Leibenluft
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6982701
• 关键词: adolescence (12-20); behavioral /social science research tag; bipolar depression; child (0-11); child behavior disorders; child mental disorders; clinical research; clinical trials; conduct disorder; disease /disorder classification; human subject; human therapy evaluation; interview; lithium; longitudinal human study; magnetic resonance imaging; mental disorder chemotherapy; mental disorder diagnosis; mood disorders; neuroanatomy; neuropsychological tests; patient oriented research

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 behaviorally 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 15 patients have completed the treatment trial, and MRS scans have been obtained. In addition, data from standardized behavioral paradigms have been obtained on approximately 35 children with severe mood dysregulation in order to identify deficits in core psychological processes associated with the disorder. These data show that children with mood dysregulation have deficts in response flexibility and social information processing that are similar, but not identical to, those of children with BPD. In addition, preliminary neuroimaging data indicate that children with BPD, but not those with severe mood dysregulation, have decreased amygdala volume.

最近，研究人员和临床医生将更多的注意力集中在一群患有严重情绪和行为失调的儿童身上。这些儿童的特点是损害症状，包括异常的基线情绪（如烦躁、愤怒和/或悲伤）、过度觉醒（如失眠、躁动、注意力不集中）和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BPD存在相当大的争论。然而，患有该综合征的儿童缺乏BPD的主要症状，并且其他DSM-IV的诊断（ADHD， ODD等）捕获了异质性的临床人群，其中包括许多没有表现出上述症状的儿童。因此，本项目的目标是：1)可靠地识别一组患有严重情绪和行为失调的儿童，以便对他们进行临床和行为表征，并对他们进行纵向跟踪；2)在该人群中开展锂的双盲、安慰剂对照试验；3)研究与双相情感障碍患者神经营养效应和磷酸肌肽信号变化相关的锂反应是否在该组患者中具有类似的效果。标准化的访谈模块和评定量表将被用来评定情绪失调的临床特征。进行锂离子双盲、安慰剂对照试验，治疗前后分别进行磁共振波谱（MRS）测定NAA和mI。大约15名患者已经完成了治疗试验，并获得了MRS扫描。此外，从标准化行为范式中获得了大约35名患有严重情绪失调的儿童的数据，以确定与该疾病相关的核心心理过程的缺陷。这些数据表明，患有情绪失调的儿童在反应灵活性和社会信息处理方面存在缺陷，这些缺陷与BPD儿童相似，但并不完全相同。此外，初步的神经影像学数据表明，患有BPD的儿童，而不是那些严重情绪失调的儿童，杏仁核体积减少。