Reward, pathophysiologic dimensions and psychological distress in young adults

年轻人的奖赏、病理生理维度和心理困扰

• 批准号: 9228405
• 负责人: Mary Louise Phillips
• 金额: $ 60.88万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9228405
• 关键词: Accident and Emergency department; Adult; Affect; Affective; Age; Ambulatory Care; Anhedonia; Antidepressive Agents; Anxiety; Attention deficit hyperactivity disorder; Behavior; Behavioral; Biological; Brain; Categories; Childhood; Clinical; Counseling; Dependence; Development; Diagnosis; Diagnostic; Dimensions; Distress; Esthesia; Ethnic Origin; Face; Factor Analysis; Family; Family history of; Feeling suicidal; Functional disorder; Funding; Future; Gender; Health Professional; Hospitalization; Impulsivity; Individual; Institutes; Interpersonal Relations; Intervention; Lateral; Lead; Lifestyle-related condition; Measures; Medial; Mental Health; Mental disorders; Mood Disorders; Neurobiology; Outcome; Patient Self-Report; Pharmaceutical Preparations; Positive Valence; Prefrontal Cortex; Primary Health Care; Problem behavior; Professional counselor; Psychiatric therapeutic procedure; Psychiatrist; Psychotherapy; Psychotic Disorders; Quality of life; Recording of previous events; Recruitment Activity; Research Domain Criteria; Rest; Rewards; Risk; Services; Students; Substance abuse problem; Symptoms; System; Training; Ventral Striatum; Visit; Youth; anxiety symptoms; base; critical developmental period; depressive symptoms; emotion regulation; experience; functional outcomes; help-seeking behavior; information processing; neural circuit; neuroimaging; novel; pediatric trauma; personalized medicine; pleasure; programs; psychologic; psychological distress; psychosocial; public health relevance; reward circuitry; reward expectancy; standardize measure; stressor; trait; treatment choice; two-dimensional; white matter; willingness; young adult

DESCRIPTION (provided by applicant): 18% of 18-25 year-olds seek help for psychological distress (e.g., depressive/anxiety symptoms, failing to cope with everyday stressors and interpersonal relationships). Yet unfortunately, there are few or no previous psychiatric history, and no biological, measures to predict future functional outcome and guide treatment choice for these vulnerable individuals. Two dimensions of behaviors and experiences that are common in these individuals, with potentially deleterious consequences for psychosocial function, are: impulsive sensation seeking, the tendency and willingness to seek, and take risks for, novel and intense sensations and experiences; and anhedonia, the inability to experience pleasure. The Research Domain Criteria is a dimensional approach to psychiatric illness that includes neural circuitry and self-report (SR) measures of behaviors related to dimensional constructs in core domains that are agnostic to DSM diagnoses. We have identified in non-help seeking (unaffected) and help-seeking (affected) adults significant relationships among neuroimaging measures of reward neural circuitry function and SR measures of the above two behaviors, that are in turn related to two positive valence systems domain constructs: reward expectancy and sustained responsiveness to reward attainment. We will recruit 150 affected 18-25 year-olds seeking help for psychological distress, irrespective of DSM diagnosis (>1 visit to student counseling/ emergency room psychiatrist/ Pittsburgh Youth and Family Training Institute (YFTI); referred to primary care/psychiatric services, continuing counseling/YFTI; unmedicated or SRI antidepressant/stimulants <2 weeks); and 125 age-, gender-, ethnicity-, SES- and IQ-matched unaffected individuals. We hypothesize: 1. Reward expectancy: greater reward circuitry activity and functional connectivity (FC) (in ventral striatum (VS), lateral orbitofrontal cortex) to monetay reward expectancy will be associated with higher scores on standardized measures of impulsive sensation seeking. Sustained responsiveness to reward attainment: greater medial prefrontal cortical activity and medial prefrontal cortical-VS FC to happy faces/monetary reward receipt will be associated with higher scores on standardized measures of anhedonia. Neuroimaging-SR relationships may differ between affected and unaffected individuals. 2. We will identify underlying factors among these neuroimaging and SR measures in all individuals, and separately in affected and unaffected individuals. 3. In affected individuals, the magnitude of many of these measures and factor scores will be significant predictors of poor outcome: no. days' hospitalization/intensive outpatient care; worsening psychological distress, affective/anxiety/ADHD symptoms, psychosocial function, quality of life; developing suicide ideation/attempt, psychosis, substance abuse/dependence. The proposed study aims to identify measures reflecting dimensions of pathophysiology in 18-25 year-olds seeking help for psychological distress, to ultimately provide neurobiological targets to guide personalized treatment, and optimize functional outcome for these vulnerable young people.

描述(申请人提供)：18%的18-25岁青少年因心理困扰而寻求帮助(例如，抑郁/焦虑症状，无法应对日常压力和人际关系)。然而，不幸的是，很少或根本没有精神病史，也没有生物学方法来预测未来的功能结果，并指导这些脆弱个体的治疗选择。这些人常见的行为和经历有两个方面，对心理社会功能具有潜在的有害后果：冲动的感觉寻求，即寻求和冒险新颖而强烈的感觉和经验的倾向和意愿；以及快感缺乏，即无法体验快乐。研究领域标准是一种精神疾病的维度方法，包括神经回路和自我报告(SR)测量行为，这些行为与DSM诊断不可知的核心领域中的维度结构有关。在非求助(未受影响的)和求助(受影响的)成年人中，我们发现奖赏神经回路功能的神经成像指标与上述两种行为的SR指标之间存在显著的关系，这反过来又与两个正价系统域结构有关：奖赏期望和对奖赏获得的持续反应。我们将招募150名受影响的18-25岁寻求心理困扰帮助的人，而不考虑DSM诊断(&gt；1次去学生咨询/急诊室精神科医生/匹兹堡青年和家庭培训研究所(YFTI)；转介初级保健/精神服务，继续咨询/YFTI；未用药或SRI抗抑郁药/兴奋剂&lt；2周)；以及125名年龄、性别、种族、SES和智商匹配的未受影响的个人。我们假设：1.奖赏期望：更大的奖赏回路活动和功能连接(Fc)(在腹侧纹状体(VS)、外侧眶前皮质)与货币日奖赏期望将与更高的脉冲感觉寻求标准化测量分数相关。对获得奖励的持续反应：更大的内侧前额叶皮质活动和内侧前额叶皮质-对快乐面孔/金钱奖励收受的FC将与快感缺失的标准化测量得分更高相关。神经影像-SR关系在受影响和未受影响的个体之间可能不同。2.我们将在所有个体中确定这些神经成像和SR测量中的潜在因素，并分别在受影响和未受影响的个体中进行识别。3.在受影响的个人中，许多这些测量的大小和因子得分将是不良结果的重要预测因素：不。住院天数/门诊重症护理；心理困扰恶化、情感/焦虑/多动症症状、心理社会功能、生活质量；产生自杀意念/企图、精神病、药物滥用/依赖。这项拟议的研究旨在确定反映18-25岁寻求心理困扰帮助的青少年的病理生理学维度的措施，最终提供神经生物学目标来指导个性化治疗，并优化这些脆弱年轻人的功能结果。