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注意力集中在一群患有严重情绪和行为失调的儿童上。这些儿童的特征是症状受损，包括基线异常情绪（即烦躁，愤怒和/或悲伤），高伴侣（例如失眠，躁动，分散性）以及对负面情绪刺激的反应性增加。由于该综合症具有许多临床特征（BPD），因此关于是否应诊断出患有BPD的孩子存在很多争论。然而，该综合征的儿童缺乏BPD的基本症状，其他DSM-IV诊断（ADHD，ODD等）捕获了异质临床人群，其中包括许多未表现出上述症状的儿童。因此，该项目的目标是1）可靠地确定一群患有严重情绪和行为失调的儿童，以便在临床和行为上表征他们，并纵向跟随他们； 2）在该人群中进行锂的双盲，安慰剂对照试验； 3）研究锂反应与两极性患者的磷酸肌营养作用以及磷酸肌醇信号的变化有关，在这组患者中是否具有相似的作用。标准化的访谈模块和评级量表将用于评估情绪失调的临床特征。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光谱（MRS）测量NAA和MI。大约有15名患者完成了治疗试验，并获得了MRS扫描。此外，已经获得了大约35名患有严重情绪失调的儿童的标准化行为范例的数据，以确定与该疾病相关的核心心理过程中的缺陷。这些数据表明，情绪失调的儿童因响应灵活性和社会信息处理而有违规，但与BPD儿童的社会信息处理相似，但并不相同。此外，初步的神经影像学数据表明，患有BPD的儿童，但没有严重的情绪失调的儿童杏仁核的体积降低。