Children: Mood Dysregulation Characterization/Treatment

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)可靠地确定一组患有严重情绪和行为障碍的儿童，以便在临床和行为方面对他们进行特征描述，并对他们进行纵向跟踪；2)在这一人群中进行锂的双盲、安慰剂对照试验；以及3)研究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15名患者已经完成了治疗试验，并进行了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，以确定与该障碍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，但不完全相同。此外，初步的神经成像数据表明，患有BPD的儿童，而不是那些严重的情绪失调的儿童，杏仁核体积减少。

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.