The Characterization And Treatment Of Children With Seve

最近，研究人员和临床医生越来越多地关注一组患有严重情绪和行为失调(SMD)的儿童。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)可靠地识别一组有严重情绪和行为障碍的儿童，以便对他们的临床和行为特征进行特征描述，并对他们进行纵向跟踪，2)比较SMD儿童的脑功能(通过功能磁共振和标准化行为测试进行评估)和明确的BPD儿童的脑功能；3)在SMD儿童中进行锂的双盲、安慰剂对照试验。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)检查，以确定锂治疗对大脑代谢物的影响。大约15名患者已经完成了治疗试验，并进行了MRS扫描。从标准化的行为范式中获得了大约80名患有SMD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。此外，还获得了大约40名SMD儿童的功能磁共振数据，这些模式也用于BPD和ADHD儿童。功能磁共振成像数据目前正在分析中。行为数据显示，SMD儿童存在与BPD儿童相似的面部情绪标签缺陷。然而，患有SMD的儿童，而不是BPD的儿童，在对惩罚性刺激的反应方面存在缺陷。数据还表明，尽管两组患者的情感反应相似，但SMD儿童和BPD儿童在对挫折的心理生理和行为反应方面存在差异。对两项纵向流行病学研究数据的事后分析表明，患有SMD的儿童比非SMD儿童更有可能在成年早期满足抑郁症的标准，但不符合BPD的标准。

Recently, researchers and clinicians have focused increased attention on a group of children with severe mood and behavioral dysregulation (SMD). 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 compare the brain function of SMD children (assessed with functional MRI and standardized behvioral testing)to that of children with unequivocal BPD; 3) to conduct a double-blinded, placebo-controlled trial of lithium in children with SMD. 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) will be preformed before and after treatment to ascertain effects of lithium treatment on brain metabolites. Approximately 15 patients have completed the treatment trial, and MRS scans have been obtained. Data from standardized behavioral paradigms have been obtained on approximately 80 children with SMD in order to identify deficits in core psychological processes associated with the disorder. In addition, functional MRI data have been obtained on approximately 40 SMD children on paradigms that have also been used in children with BPD and ADHD. The fMRI data are currently being analyzed. The behavioral adata show that children with SMD have face emotion labeling deficits that are similar to those of children with BPD. However, children with SMD, but not those with BPD, have deficits in their responses to punishing stimuli. Data also indicate that children with SMD differ from those with BPD in their psychophysiological and behavioral responses to frustration, although the affective responses of the two patient groups are similar. A post-hoc analysis of data from two longitudinal epidemiological studies indicate that children with SMD are more likely than non-SMD children to meet criteria for depression, but not BPD, in early adulthood.