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Understanding/ Treating Neuropsychiatric Symptoms of Pediatric Physical Illness

了解/治疗小儿身体疾病的神经精神症状

基本信息

批准号：
7425559
负责人：
EVA M SZIGETHY
金额：
$ 226.5万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-30 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7425559
关键词：
Abdominal Pain Academy Accident and Emergency department Accounting Acquired Immunodeficiency Syndrome Acute Adolescence Adolescent Adolescent Development Adolescent Psychiatry Adult Adverse effects Affect Affective Age Albumins Algorithms American Amygdaloid structure Analysis of Variance Angiotensin Receptor Anhedonia Animals Antidepressive Agents Anxiety Appointment Area Arts Asthma Attention Autoimmune Diseases Autoimmune Process Autonomic nervous system Award Basal Nucleus of Meynert Base of the Brain Basic Science Behavior Behavior Therapy Behavioral Behavioral Paradigm Belief Biochemical Biological Biological Sciences Biopsy Blood Boston Brain Brain Stem Brain imaging Brain region C-reactive protein Caliber Canis familiaris Caring Categories Cell Nucleus Characteristics Charge Chest Child Child Care Childhood Cholecystokinin Chronic Chronic Childhood Arthritis Chronic Disease Circadian Rhythms Cities Classification Clinic Clinical Clinical Data Clinical Sciences Clinical Trials Cognition Cognitive Cognitive Therapy Cognitive deficits Collaborations Colonoscopy Communication Communities Complex Computer information processing Computer software Computers Condition Conflict (Psychology)Consult Control Groups Coping Skills Cosmetics Coupling Crohn&apos s disease Cross-Sectional Studies Cues Cultural Backgrounds DNA DSM-IV Daily Data Data Analyses Depressed mood Depressive disorder Desire for food Development Devices Diagnosis Discipline Disease Disease regression Disease remission Disruption Doctor of Philosophy Dopamine Dose Economics Educational process of instructing Effectiveness Effectiveness of Interventions Electrons Emotional Emotions Empathy Endogenous depression Enrollment Environment Environmental Risk Factor Equation Equilibrium Equipment and supply inventories Erythrocyte Sedimentation Rate Etiology Evaluation Event Exclusion Criteria Exhibits Exposure to Eye Face Facilities and Administrative Costs Family Fatigue Feeling Female Fistula Flare Foundations Frequencies Functional Imaging Functional Magnetic Resonance Imaging Functional disorder Future Gastroenterology Gastrointestinal tract structure Gender Generations Genetic Genotype Glucocorticoids Goals Grant Grant Review Process Growth Head Health Health Care Costs Health Services Health Status Heart Heart Diseases Heart Rate Hematocrit procedure Hemorrhage Hepatology Heterogeneity Hippocampus (Brain)Hospitalization Hour Human Hungary Hydrocortisone Hypertension Image Immune Immune System and Related Disorders Immunology Impaired cognition Impairment Individual Inflammation Inflammatory Inflammatory Bowel Diseases Inflammatory Response Inpatients Institutes Interferons Interleukin-10 Interleukin-12 Interleukin-6 Intervention Interview Intestines Investigation Journals K-Series Research Career Programs Knowledge Laboratories Learning Length of Stay Leukocytes Life Linear Models Link Literature Localized Location Logistics Magnetic Resonance Imaging Maintenance Major Depressive Disorder Malignant Neoplasms Manuals Masks Master&apos s Degree Measurement Measures Mediating Mediation Mediator of activation protein Medical Medical History Medical Records Medical center Medicine Memory Mental Depression Mentorship Meta-Analysis Metabolism Microscopic Modeling Modification Mood Disorders Moods Morbidity - disease rate Mutation Mydriasis National Institute of Mental Health Neuro-Oncological Ventral Antigen 2 Neuroanatomy Neurobiology Neurologic Neuronal Plasticity Neuropeptides Neurosciences Neurotensin Neurotransmitters Nucleus Accumbens Operative Surgical Procedures Outcome Outpatients Pain Parents Participant Pathway interactions Patients Pattern Pediatric Hospitals Peripheral Personal Satisfaction Persons Pharmaceutical Preparations Pharmacotherapy Phenotype Physiologic Monitoring Physiologic pulse Physiological Pilot Projects Play Pliability Population Prednisone Prefrontal Cortex Pregnancy Tests Prevalence Prevention Prize Probability Procedures Process Proteins Provider Proxy Psychiatric Diagnosis Psychiatric therapeutic procedure Psychiatrist Psychiatry Psychological reinforcement Psychology Psychopathology Psychopharmacology Psychosocial Factor Puberty Public Health Publications Pulse taking Pupil Quality of life Questionnaires Randomized Randomized Controlled Trials Range Rate Recovery Recruitment Activity Regulation Relative (related person)Relaxation Reporting Research Research Design Research Infrastructure Research Personnel Respiration Rest Rewards Risk Role Running Sample Size Sampling Savings Scanning Science Scientist Score Screening procedure Secondary to Selective Serotonin Reuptake Inhibitor Series Severities Severity of illness Short-Term Memory Sickle Cell Anemia Silk Site Sleep Sleep Deprivation Sleep disturbances Sleeplessness Slice Social Functioning Social support Socialization Societies Sodium Chloride Specificity Staging Standards of Weights and Measures Steroids Stigmata Stimulus Stratification Stress Structural Models Structure Students Substantia nigra structure Supervision Supportive care Surrogate Markers Susceptibility Gene Symptoms Synapses System Teaching Materials Techniques Technology Teenagers Telephone Testing Therapeutic Therapeutic Effect Thinking Time Training Translating Translational Research Transportation Treatment Cost Ulcerative Colitis United States National Institutes of Health Universities Upper arm Urine Utah Variant Visit Week Weight Well in self Work Writing Youth abstracting auditory stimulus base behavioral health behavioral/social science body system brain metabolism career child depression cholinergic neuron chronic pain clinically relevant clinically significant cognitive change cognitive function cohort collaborative care comorbidity comparison group computer generated concept conditioning coping cost cost effective cost effectiveness cysteine rich protein cytokine data modeling day depressive symptoms design deviant dietary restriction dopaminergic neuron executive function experience follow-up functional loss gastrointestinal system genetic risk factor health economics health related quality of life illness perceptions immune function improved indexing inflammatory pain innovation interest man medical schools medication compliance mortality neurobehavioral neurodevelopment neuroimaging neuronal cell body neurophysiology neuropsychiatry neurotoxicity novel nutrition prevent programs prospective prototype psychoeducation psychosocial receptor reinforced behavior relating to nervous system response skills skills training social skills social stigma software development stem tertiary care theories therapy adherence therapy design time use treatment effect virtual reality visual stimulus way finding willingness

项目摘要

Abstract Depression is costly and has detrimental effects on disease course in physically ill populations. This proposal takes a novel multi-dimensional approach to assess the neurobiological basis of depression in chronic pediatric physical illness using inflammatory bowel disease (IBD) as a model. It also evaluates the efficacy of a modified cognitive behavioral therapy (CBT) on emotional well-being, physical health, economic costs, and neurobiological outcomes. These results will provide key building blocks for a paradigm shift within medicine by integrating behavioral health into the comprehensive medical care of physical illnesses. Little is known about how the brain and body interact to increase depressive vulnerability, particularly during key developmental periods during childhood and adolescence. Adult studies identify disruptions in limbic and prefrontal brain activity in the pathophysiology of depression. Cytokines secondary to inflammation and exogenous treatment with steroids can cause mood and cognitive changes in these same brain regions. It is important to understand the neuropsychiatric effects of IBD and its treatment on underlying brain structures during adolescence, a critical developmental period for brain maturation underlying emotional regulation and cognitive processing. More importantly, neuronal plasticity during adolescence may still allow reversibility of disease-related brain effects through teaching coping strategies for life-long illness management that could change developmental trajectories and reduce vulnerability in adulthood. Using translational neuroscience approaches, this proposal will examine: 1) brain regions that underlie emotional and cognitive processing in youth with active IBD and depression using brain functional magnetic resonance imaging compared to youth with IBD and no depression, and normal controls; and 2) the efficacy of a combined CBT-physical illness narrative intervention targeting emotional and cognitive processing compared to supportive non-directive therapy at: (a) improving emotional well being; (b) alleviating physical symptoms; and (c) reducing health care costs.

摘要抑郁症是昂贵的，并对身体不适人群的疾病进程产生有害影响。这建议采取一种新颖的多维方法来评估抑郁症的神经生物学基础，使用炎症性肠病（IBD）作为模型的慢性儿科身体疾病。它还评估了改良认知行为疗法（CBT）对情绪健康、身体健康、经济成本和神经生物学结果。这些结果将为内部的范式转变提供关键的构建块通过将行为健康融入身体疾病的综合医疗保健，关于大脑和身体如何相互作用以增加抑郁症的脆弱性，特别是在儿童和青少年时期的关键发展时期。成人研究确定了边缘系统的中断，抑郁症病理生理学中的前额脑活动。继发于炎症和用类固醇进行外源性治疗可以在这些相同的大脑区域引起情绪和认知变化。是重要的是要了解炎症性肠病的神经精神影响及其对大脑结构的治疗在青春期，这是大脑成熟的关键发育期，是情绪调节的基础，认知加工更重要的是，青春期的神经元可塑性可能仍然允许可逆性，通过教授终身疾病管理的应对策略，改变发展轨迹，减少成年后的脆弱性。使用翻译神经科学的方法，这项建议将检查：1）大脑区域，利用脑功能磁共振技术研究患有活动性IBD和抑郁症的青年人的情绪和认知加工与患有IBD且无抑郁症的青年和正常对照组相比的共振成像;以及2）一项针对情绪和认知处理的CBT-身体疾病叙事干预，支持性非指导性治疗：（a）改善情绪健康;（B）减轻身体症状; 及（c）减低医疗费用。