Early Assessment and Intervention for Adolescents at Risk for Bipolar Disorder

描述（由申请人提供）：双相情感障碍（BP）发展的最有力的风险因素是患有该疾病的一级家庭成员。因此，父母患有BP的后代是一个特别高的风险群体，通常会经历早期发病，严重的过程，以及高比例的共病精神疾病。众所周知，睡眠调节不良与情绪障碍生物易感性个体的抑郁和躁狂发作有关。此外，有证据支持睡眠障碍的高危青年谁还没有发展阈值情绪障碍。这项拟议的研究旨在解决这一核心问题，我们认为这一问题会使处于危险之中的年轻人面临更大的BP睡眠和社会节奏中断的风险。由于青春期是一个以睡眠/觉醒模式和社会惯例的显著改变为特征的时期，因此这一时期可能被证明是评估和治疗高危人群睡眠和精神症状的最佳时期。我们调整并试行了人际和社会节律疗法（IPSRT），这是一种针对成人BP患者的辅助治疗，可帮助患者稳定睡眠/觉醒周期和日常生活，适用于高危青少年。初步数据表明，这种方法对BP发展的风险青年有希望。我们还确定了对BP前的异质性条件进行干预，作为预防或延迟高危青年BP发作的第二条途径。因此，拟议研究的目的是进一步开发和检查青少年（12-18岁）的后代与BP父母的IPSRT。该研究涉及进行一项小型对照试验（n=50），比较简单IPSRT +数据知情转诊与单独数据知情转诊，以收集与干预相关的可行性、可接受性和近端结局的初步数据。所有参与者在基线时接受精神病理学和睡眠障碍的全面评估（通过客观和主观方法），然后进行一次反馈会议，审查结果。如有临床指征，将为青少年提供数据知情转介任何精神症状/障碍，在摄入评估。然后将青少年随机分为接受简明IPSRT或不接受简明IPSRT;随机化将根据睡眠障碍和精神病理学进行分层。将在6个月内的4个时间点评估所有受试者的结局。数据将用于为未来对照试验的设计和实施提供信息。拟议的方法是在直接雅阁与NIMH战略计划中概述的战略，其中开发和测试创新的干预措施，以减少风险和积极改变精神疾病的轨迹是由研究结果有关强大的和可塑性的风险因素和疾病的核心特征。这一领域的研究具有重要的公共卫生意义，因为它有可能预防，延迟或改善这种慢性和毁灭性疾病在高风险人群中的进展。

DESCRIPTION (provided by applicant): The most potent risk factor for the development of bipolar disorder (BP) is a first-degree family member with the illness. Thus, offspring of parents with BP are a particularly high-risk group and typically experience early illness onset, severe course, and high rates of comorbid psychiatric disorders. It is well-established that poor sleep regulation is associated with the onset of depressive and manic episodes among individuals with a biological vulnerability to mood disorder. Furthermore, evidence supports sleep disturbance in at-risk youth who have not yet developed threshold mood disorders. The proposed study aims to address this core disturbance that we argue puts at-risk youth at even greater risk for development of BP-sleep and social rhythm disruption. Since adolescence is a period characterized by significant alterations in sleep/wake patterns and social routines, this period may prove optimal for assessment and treatment of sleep and psychiatric symptoms in those at-risk. We adapted and piloted Interpersonal and Social Rhythm Therapy (IPSRT), an empirically-supported treatment for adults with BP that helps patients stabilize sleep/wake cycles and daily routines, for at-risk adolescents. Preliminary data indicate this approach holds promise as for youth at-risk for the development of BP. We also identified intervention for the heterogeneous conditions antecedent to BP as a second path to preventing or delaying BP onset in at-risk youth. The purpose of the proposed study is thus to further develop and examine IPSRT for the adolescent (age 12-18) offspring of parents with BP. The study involves conduct of a small controlled trial (n=50) comparing Brief IPSRT + Data-Informed Referral versus Data-Informed Referral alone to gather preliminary data on feasibility, acceptability and proximal outcomes associated with the intervention. All participants receive a thorough assessment of psychopathology and sleep disturbance (via objective and subjective methods) at baseline, followed by a single feedback session reviewing the findings. As clinically indicated, youth will be offered Data-Informed Referral for any psychiatric symptoms/disorders identified during the intake assessment. Youth will then be randomized to receive either Brief IPSRT or no Brief IPSRT; randomization will be stratified on sleep disturbance and psychopathology. Outcomes will be assessed at 4 time points over 6 months in all participants. Data will be used to inform the design and conduct of a future controlled trial. The proposed approach is in direct accord with strategies outlined in the NIMH Strategic Plan in which the development and testing of innovative interventions to reduce risk and positively alter trajectories of mental illness are informed by research findings regarding robust and malleable risk factors and core features of disease. Research in this area is of great public health importance, as it has the potential to prevent, delay, or ameliorate the progression of this chronic and devastating illness in those at highest risk.