COGFLEX: Pilot Translational Intervention for Pediatric Bipolar Disorder

描述(申请人提供)：儿童双相情感障碍(BD)是一个日益严重的健康问题，其发病率在过去十年中增加了40倍，现在占所有从精神病院出院的儿童的20%。在目前针对这一迅速增长的公共卫生问题的治疗方法中，几乎没有一种是基于我们对儿科BD生物学的理解。越来越多的研究表明，儿科BD涉及到调节认知灵活性的行为和大脑变化--即调整一个人的思维和行为并对不断变化的奖励做出反应的能力。这包括我自己的工作，表明BD青少年在反向学习中有行为和功能磁共振神经改变。这项R21/R33翻译新干预拨款申请的主要目标是加速将我们的数据转化为一种使用计算机辅助认知补救的逆转学习(简称COGFLEX)的新型、基于机制的非药物干预，该数据涉及逆转学习中的脑/行为改变和儿科BD病理生理学中的认知灵活性。我们的中心假设是，COGFLEX对儿童BD是可行和可接受的，因为其他人已经表明，对于患有BD、单相抑郁、ADHD和精神分裂症的成人以及ADHD儿童，COGFLEX是一种可行、可接受和有效的相关认知过程的干预措施。我们的研究方法：R21阶段：与我们的跨学科专家团队合作，在视频游戏开发、治疗开发、儿童认知补救、儿科BD和生物统计学方面，我们将完善我们的COGFLEX干预措施，收集50名典型发育儿童的技能培养水平的规范数据，并对15名BD儿童进行COGFLEX对行为、大脑和症状影响的第一阶段公开试验。R33阶段：我们将在40名儿童BD参与者中进行1b阶段的可行性和可接受性随机对照试验，一半随机接受具有10个技能培养水平的全面COGFLEX干预，另一半接受对照任务(仅COGFLEX 1级)。我们将改进我们的干预措施，并提交一份专门设计和支持的R01申请，以测试其对儿童BD的疗效。意义：我们的方法与PAR 11-177和NIMH的战略3.1开发新的干预措施和1.4 RDoC项目的目标一致，因为我们寻求为儿科BD开发一种基于机制的新型非药物干预措施，应用从可观察行为和神经成像研究中获得的经验教训-即逆转学习。因此，该项目有可能通过允许对新的基于机制的干预措施进行关键改进来改变儿童BD的NIMH高优先级领域的治疗。

DESCRIPTION (provided by applicant): Pediatric bipolar disorder (BD) is a growing health problem, whose incidence has risen 40-fold in the past decade and now accounts for 20% of all children discharged from psychiatric hospitals. Of the current treatments for this burgeoning public health problem, virtually none are based on our understanding of the biology of pediatric BD. A growing body of research has shown that pediatric BD involves behavioral and brain alterations mediating cognitive flexibility-i.e., the ability to adapt one's thinking and behavior n response to changing rewards. This includes my own work showing that BD youths have behavioral and functional MRI neural alterations in reversal learning. THE PRIMARY OBJECTIVE of this R21/R33 Translational Novel Interventions grant application is to accelerate the translation of our data implicating brain/behavior alterations in reversal learning and cognitive flexibility in the pathophysiology of pediatric BD into a novel, mechanism-based, non-medication intervention using computer-assisted cognitive remediation for reversal learning (referred to as COGFLEX). OUR CENTRAL HYPOTHESIS is that COGFLEX will be feasible and acceptable for pediatric BD, given that others have shown similar interventions for related cognitive processes are a feasible, acceptable, and effective treatment component for adults with BD, unipolar depression, ADHD, and schizophrenia, and in children with ADHD. OUR RESEARCH METHOD: R21 PHASE: In collaboration with our cross-disciplinary team of experts in video game development, treatment development, cognitive remediation in children, pediatric BD, and biostatistics, we will refine our COGFLEX intervention, gather normative data for skill-building levels in 50 typically-developing children, and conduct a stage 1a open trial of the behavior, brain, and symptom effects of COGFLEX on 15 BD children. R33 PHASE: We will conduct a stage 1b randomized controlled trial of feasibility and acceptability in 40 pediatric BD participants, half randomized to receive the full COGFLEX intervention with 10 skill-building levels, and half receiving a control task (COGFLEX level 1 only). We will refine our intervention and submit an R01 application specifically designed and powered to test its efficacy for pediatric BD. SIGNIFICANCE: Our approach aligns with the objectives of PAR 11-177 and NIMH's strategies 3.1 Develop Novel Interventions and 1.4 RDoC project because we seek to develop a novel, mechanism-based non- medication intervention for pediatric BD, applying lessons learned from studies of observable behavior and neuroimaging-i.e., reversal learning. Thus, this project has the potential to transform the treatment for the NIMH high-priority area of pediatric BD by allowing critical refinements for a novel mechanism-based intervention.