Brain Connectivity and Mindfulness Training in Youth with Bipolar Disorder NOS

双相情感障碍青少年的大脑连接和正念训练 NOS

• 批准号: 8568144
• 负责人: KIKI D CHANG
• 金额: $ 17.98万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-19 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8568144
• 关键词: 18 year old; Adolescence; Adolescent; Adult; Adverse effects; Affect; Amygdaloid structure; Anterior; Area; Award; Awareness; Biological; Biological Neural Networks; Bipolar Disorder; Brain; Breathing; Child; Childhood; Chronic; Clinical; Clinical Research; Collaborations; Consultations; Data; Development; Diagnostic; Disease; Dorsal; Early Intervention; Early identification; Emotional; Emotions; Esthesia; Event; Faculty; Family; Family history of; Functional Magnetic Resonance Imaging; Funding; Goals; Group Therapy; Health Care Costs; Hippocampus (Brain); Individual; Intervention; Judgment; Knowledge; Lead; Left; Magnetic Resonance Imaging; Major Depressive Disorder; Mental Depression; Mentors; Methodology; Methods; Midcareer Investigator Award in Patient-Oriented Research; Mood Disorders; Moods; Morbidity - disease rate; National Institute of Mental Health; Neurobiology; Outcome; Parents; Pathway interactions; Pharmaceutical Preparations; Pilot Projects; Population; Populations at Risk; Postdoctoral Fellow; Prefrontal Cortex; Prevention; Public Health; Randomized Controlled Trials; Recording of previous events; Recurrence; Research; Research Personnel; Research Project Grants; Resources; Rest; Risk; Risk Factors; Role; Second Degree Relative; Severities; Specific qualifier value; Strategic Planning; Structure; Students; Symptoms; System; Teenagers; Therapeutic Intervention; Time; Training; Youth; base; career; cingulate cortex; daily functioning; density; depressive symptoms; disorder prevention; early onset; emotional experience; experience; gray matter; high risk; improved; innovation; meetings; mindfulness; mindfulness meditation; mindfulness-based stress reduction; morphometry; mortality; neuromechanism; next generation; novel; patient oriented; patient oriented research; public health relevance; relating to nervous system; response; skills; stressor; therapy design; young adult

DESCRIPTION (provided by applicant): The long-term objective of this Midcareer Investigator Award in Patient-Oriented Research (K24) Award is to provide time and resources to the candidate to continue and expand his mentoring activities of trainees in clinical research careers in the field of innovative methods for early identification and prevention of pediatric mood disorders. Furthermore, the candidate will develop his own career in the areas of advanced MRI methodologies and mindfulness-based therapies in order to use this knowledge to better investigate neural network abnormalities that create risk for early-onset bipolar disorder (BD) and how interventions can reverse these developmental abnormalities. The candidate will reach this goal through relevant coursework, scientific meetings, outside consultation, internal collaboration and mentoring, and completion of a proposed research project relating these fields to youth with BD, not otherwise specified (BD NOS). Bipolar disorder is a common, chronic, and often disabling disorder that carries significant public health burden and commonly begins in childhood or adolescence. Understanding how brain development leads to BD development would aid in developing targeted interventions for early intervention and prevention. Given the unclear adverse effects of psychotropic medications on developing brains, non-pharmacologic interventions in populations at risk for BD should also be explored. Mindfulness based therapies (MBT) have been successfully used to treat adults and children with depression, and adults with bipolar disorder. This application proposes examination of baseline resting state neural networks in youth at high-risk for BD, and the effects of a MBT intervention on these networks and on brain morphometry. First, we will study 30 adolescents (13-17 yo) who meet criteria for BD NOS, strictly defined per standardized research criteria. Subjects will also have a first- or second-degree relative with BD, creating a group at very high risk of progressing to bipolar I disorder within four years. We will use resting state-fMRI (rs-fMRI) to examine default mode networks (DMN) in these 30 subjects and compare with already acquired data from 20 healthy controls (HC). We hypothesize that youth with BD NOS will have altered subgenual anterior cingulate (sgACC) functional connectivity (FC) compared with HC: higher FC of sgACC with the DMN and lower FC of the sgACC with the dorsal anterior cingulate and dorsolateral prefrontal cortex. Second, these subjects will be treated with a 12-week Mindfulness Based Stress Reduction for Teens (MBSR-T) intervention, designed to increase daily mindfulness, meditation skills, and awareness of emotional dysregulation in response to stressors. We hypothesize that youth with BD NOS will experience decreases in depressive symptoms and degree of mood dysregulation, and increases in functioning and degree of mindfulness practice. Furthermore, we anticipate that FC of sgACC with DMN will decrease and FC of sgACC with dorsal structures will increase, as will left hippocampal volume. Consistent with the NIMH Strategic Plan, this study will examine neurobiological risk factors for mood disorder development in youth and neural mechanisms of a novel intervention that has potential for prevention, while creating additional opportunities for mentoring the next generation of clinical researchers in the field of pediatric mood disorder prevention.

描述（由申请人提供）：这个以患者为导向的研究（K24）奖的中期职业研究者奖的长期目标是为候选人提供时间和资源，以继续和扩大他在临床研究职业中的实习生指导活动，在早期识别和预防儿科情绪障碍的创新方法领域。此外，候选人将在先进的MRI方法和正念疗法领域发展自己的职业生涯，以便利用这些知识更好地研究神经网络异常，这些异常会导致早发性双相情感障碍（BD）的风险，以及干预措施如何逆转这些发育异常。候选人将通过相关的课程，科学会议，外部咨询，内部合作和指导，以及完成与这些领域相关的拟议研究项目与BD青年，而不是其他指定（BD NOS）来实现这一目标。 双相情感障碍是一种常见的、慢性的、经常致残的疾病，它带来了重大的公共卫生负担，通常始于儿童或青少年时期。了解大脑发育如何导致BD发展将有助于制定有针对性的干预措施，以进行早期干预和预防。鉴于精神药物对大脑发育的不良影响尚不清楚，还应探讨对BD风险人群的非药物干预。正念疗法（MBT）已成功用于治疗成人和儿童抑郁症，以及成人双相情感障碍。本申请提出了基线静息状态的神经网络在BD的高风险青年，和MBT干预对这些网络和脑形态的影响检查。首先，我们将研究30名符合BD NOS标准的青少年（13-17岁），严格按照标准化研究标准定义。受试者也将有一个一级或二级亲属与BD，创造一个非常高的风险，在四年内进展为双相I型障碍的群体。我们将使用静息状态功能磁共振成像（rs-fMRI）检查默认模式网络（DMN）在这30个主题，并与已经获得的数据从20个健康对照（HC）进行比较。我们假设，与HC相比，BD NOS青年将改变膝下前扣带回（sgACC）功能连接（FC）：sgACC与DMN的FC较高，sgACC与背侧前扣带回和背外侧前额叶皮层的FC较低。其次，这些受试者将接受为期12周的正念减压青少年（MBSR-T）干预，旨在增加日常正念，冥想技能和对压力源的情绪失调的认识。我们假设患有BD NOS的青少年将经历抑郁症状和情绪失调程度的减少，以及功能和正念练习程度的增加。此外，我们预计，与DMN的FC的sgACC将减少和FC的sgACC与背侧结构将增加，将左海马体积。与NIMH战略计划一致，本研究将研究青少年心境障碍发展的神经生物学风险因素和具有预防潜力的新型干预措施的神经机制，同时为指导下一代临床研究人员创造额外的机会。