The Characterization And Treatment Of Children With Seve

七岁儿童的特征和治疗

• 批准号: 7312877
• 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/7312877
• 关键词: Characterization; Treatment; Children; Seve

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.

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。这些儿童的特征是损害症状，包括异常的基线情绪（即易怒，愤怒和/或悲伤），过度觉醒（例如失眠，激动，注意力分散）和对负面情绪刺激的反应性增加。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，因此对于这些儿童是否应诊断为BPD存在相当大的争议。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）。捕获异质性临床人群，包括许多未表现出上述症状的儿童。因此，本研究的目的是：1）可靠地识别出一组严重情绪和行为失调的儿童，以便从临床和行为上描述他们的特征，并纵向跟踪他们，2）比较SMD儿童的脑功能（通过功能性MRI和标准化行为测试评估）与明确BPD儿童的差异; 3）在SMD儿童中进行双盲、安慰剂对照试验。将使用标准化访谈模块和评定量表对情绪失调的临床特征进行评定。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），以确定锂治疗对脑代谢物的影响。大约15名患者完成了治疗试验，并获得了MRS扫描。从标准化的行为范例的数据已获得约80名儿童SMD，以确定缺陷的核心心理过程与障碍。此外，还获得了大约40名SMD儿童的功能性MRI数据，这些数据也用于BPD和ADHD儿童。目前正在分析fMRI数据。行为测试结果显示，SMD儿童与BPD儿童存在相似的面孔情绪标记缺陷。然而，SMD儿童，而不是BPD儿童，在对惩罚性刺激的反应中存在缺陷。数据还表明，SMD儿童与BPD儿童在心理生理和行为上对挫折的反应不同，尽管两个患者组的情感反应相似。对两项纵向流行病学研究数据的事后分析表明，在成年早期，SMD儿童比非SMD儿童更有可能符合抑郁标准，但不符合BPD标准。