2/2-Predicting Adult Outcomes in Bipolar Youth (PROBY)

项目总结/摘要 儿童双相情感障碍（BP）的负面后果是有据可查的，但过程，结果， 青年期BP向成年期过渡的预后因素尚不清楚。为了回答这些问题， 预测BP青年的成人结局（PROBY），一项多中心研究（匹兹堡大学，PI：B.Birmaher; 布朗大学，PI：M.Keller/S.Yen;加州大学洛杉矶分校，PI：M.Strober）建议：1）延长前瞻性随访 的过程和结果的双相青年（COBY）队列到成年，和2）使用COBY数据， 构建风险计算器，以预测短期（2年）、中期（5年）和长期（10年）个性化 情绪过程/结果，捕捉从青春期到成年期的过渡。我们将学习五个关键 与BP相关的领域：1）情绪和非情绪障碍的过程; 2）心理社会功能; 3） 自杀倾向; 4）SUD; 5）认知功能。风险计算是一种分析方法， 组预测，根据患者的年龄， 存在多种风险因素。PROBY中提出的风险计算器将通过以下方式对人口产生真正的影响： 预测血压结果，类似于用于心血管疾病和癌症，但很少应用于 精神疾病风险计算器将包括完善的变量，以便能够复制 和临床实用性。此外，这些变量在临床环境中很容易确定，并且是标准的一部分。 实践，因此，将广泛传播，并在日常临床实践中的实用性的承诺。为 例如，结果可用于：就长期预后向患者/家属提供咨询;个性化治疗 通过识别可能需要长期治疗的患者和可能减少药物治疗的患者， 风险最小;并为早期干预/预防和临床/生物学研究提供信息。追求 建议的研究，343名COBY受试者（BP-Ⅰ = 72.3%，BP-Ⅱ = 14.6%，BP-NOS = 13.1%，平均年龄26.3（18.7-33.7）， 47%的女性，82%的白人，平均为中产阶级），将进行2次额外的临床评估 五年的学习。这些受试者占2000年至2010年期间入组的原始样本（n=446）的77%。 2006年，在三个研究中心。PROBY将继续前瞻性收集分类和 维度精神病理学，保护因素，社会心理功能（例如，关系，工作，学术）， 认知功能、炎症标志物、心脏代谢疾病、接触压力/创伤性生活 事件和治疗（例如，药物剂量、屏障）。经过5年的前瞻性观察， 样本的平均年龄为31.3岁（23.7-38.7岁）。因此，PROBY将是第一项研究， 足够的样本量来回答关于BP青年长大后会发生什么的问题。此外，委员会认为， PROBY将是第一个建立风险计算器的研究，以预测与BP相关的关键领域的结果， 使用来自抑郁症合作研究的独立成人BP样本（n=427）验证这些结果 (CDS; R01 MH025416）。这些风险计算器有可能广泛改变BP的临床护理。

Project Summary/Abstract The negative consequences of pediatric bipolar disorder (BP) are well documented, but the course, outcome, and prognostic factors of BP as youth transit into adulthood remain unknown. To answer these questions, the Predicting Adult Outcomes in BP Youth (PROBY), a multisite study (University of Pittsburgh, PI: B.Birmaher; Brown University, PIs: M.Keller/S.Yen; UCLA, PI: M.Strober), proposes: 1) to extend the prospective follow-up of the Course and Outcome of Bipolar Youth (COBY) cohort into adulthood, and 2) to use COBY data to build risk calculators to predict short-(2 years), intermediate-(5 years), and long-term (10 years) personalized mood course/outcome that capture transitions from adolescence through adulthood. We will study five key domains relevant for BP: 1) course of mood and non-mood disorders; 2) psychosocial functioning; 3) suicidality; 4) SUD; and 5) cognitive functioning. Risk calculation is an analytic approach that instead of group prediction, yields individualized estimates of risk for a specified event in a given patient, based on the presence of multiple risk factors. The risk calculators proposed in PROBY will have a true population impact by predicting BP outcomes, similar to those used in cardiovascular disease and cancer, but rarely applied in psychiatric disorders. The risk calculators will include well-established variables, in order to allow replication and clinical utility. Also, these variables are easily ascertained in clinical settings and are part of standard practice and thus, will be widely disseminable, and hold promise for utility in daily clinical practice. For example, results may be used to: counsel patients/families about long-term prognosis; individualize treatment by identifying patients likely to require prolonged treatments and those for whom medications may be reduced with minimal risk; and inform early intervention/prevention and clinical/biological research. To pursue the proposed study, 343 COBY subjects (BP-I=72.3%, BP-II=14.6%, BP-NOS=13.1%, mean age 26.3 (18.7–33.7), 47% female, 82% Caucasian, and on average, middle class), will have 2 additional clinical assessments over the five years of study. These subjects represent 77% of the original sample (n=446) enrolled between 2000 and 2006 at the three study sites. PROBY will continue to prospectively collect data on categorical and dimensional psychopathology, protective factors, psychosocial functioning (e.g., relationships, work, academics), cognitive functioning, inflammatory markers, cardiometabolic conditions, exposure to stressful/traumatic life events, and treatment (e.g., medication dosages, barriers). With 5 additional years of prospective observation, the mean age of the sample will be 31.3 years old (23.7–38.7). Thus, PROBY will be the first study with adequate sample size to answer questions about what happens to BP youth when they grow up. Furthermore, PROBY will be the first study to build risk calculators to predict outcome in key domains relevant for BP and validate these results using an independent adult BP sample (n=427) from the Collaborative Depression Study (CDS; R01 MH025416). These risk calculators have the potential to widely transform clinical care of BP.