Optimizing Outcomes in Bipolar Illness Interventions in Hispanic Communities

位于圣安东尼奥的德克萨斯大学健康科学中心提议建立一个干预和/或服务研究高级中心，以开展个性化的基于社区的双相情感障碍治疗研究，以改善结果。我们将研究文化因素、依从性和参与、行为领域和生物因素与结果的相互作用，从而提供一个可以改变当前双相情感障碍诊断和治疗范例的模型。这项应用的一个主要目的是更好地发展我们对西班牙裔美国人双相情感障碍的理解，特别是文化适应对治疗方案依从性的影响。该项目将培训研究人员更有效地与美国最大的少数民族人群合作，特别是墨西哥裔美国人，他们构成了美国西班牙裔的大多数。我们将把我们开发的知识和方法传播给更大的美国西班牙裔美国人社区，以及为双相情感障碍患者提供护理的临床医生。该中心的研究将招募在社区环境中接受护理的所有患者的代表。这些项目将有助于开发更具成本效益的治疗方案，这些方案将根据患者的特点进行个性化治疗，并将耐受性与疗效同等重视。我们将开发和颁布研究设计，解决持续获益和功能结果，对双相情感障碍基本症状域的敏感评估，以及强调患者功能的统计方法。这些努力将由我们在双相情感障碍研究方面的全国公认的领导小组、经验丰富的科学工作人员（其中大多数也是西班牙裔）和双相情感障碍各方面研究的国家领导推动。这些努力将使我们具备作为国家资源的能力，以推进NIMH的使命，即减轻双相情感障碍的负担，通过研究治疗方法及其对患者的可接受性来改善结果，并广泛传播这项研究，以改善临床护理、公共教育和公共卫生规划。

The University of Texas Health Science Center at San Antonio proposes to establish an Advanced Center for Interventions and/or Service Research to conduct research that will personalize community based treatment of bipolar disorders to improve outcomes. We will investigate interactions of cultural factors, adherence and engagement, behavioral domains and biological factors with outcomes, thereby providing a model that can transform current diagnostic and treatment paradigms for bipolar disorder. A major aim of this application is to better develop our understanding of bipolar disorder in the Hispanic American population, in particular the impact of acculturation on adherence to treatment programs. This program will train researchers to work more effectively with this largest U.S. minority population, particularity Mexican Americans who form the majority of Hispanics in the U.S. We will disseminate the knowledge and methodologies we develop to the larger U.S. Hispanic American community, as well as clinicians providing care for persons with bipolar disorder. The studies of the Center will enroll patients who are representative of the full spectrum of patients who receive care in community settings. These projects will contribute to development of more cost effective treatment regimens that are personalized to the characteristics of the patient and weigh tolerability as highly as efficacy. We will develop and promulgate study designs addressing sustained benefit and functional outcomes, sensitive assessments of the fundamental symptom domains in bipolar disorder, and statistical approaches that emphasize patient function. These efforts will be facilitated by our group of nationally recognized leaders in bipolar studies, an experienced scientific staff, the majority of whom are also Hispanic, and national leaders of research on diverse aspects of bipolar disorder. These efforts will equip us to serve as a national resource to advance the NIMH mission of reducing the burden of bipolar illness and improve outcomes through the efforts of research about treatments and their acceptability to patients, and broadly disseminate this research for the purposes of improving clinical care, public education and public health planning.