1/2 Predicting Adult Outcomes in Bipolar Youth (PROBY)

1/2 预测双相情感障碍青少年的成年结局 (PROBY)

• 批准号: 10088476
• 负责人: BORIS BIRMAHER
• 金额: $ 48.53万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-10 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088476
• 关键词: 3 year old; 7 year old; Address; Adolescence; Adult; Age; Anxiety Disorders; Attention deficit hyperactivity disorder; Bipolar Disorder; Cardiovascular Diseases; Cardiovascular system; Categories; Caucasians; Childhood; Clinical; Clinical assessments; Counseling; Data; Development; Dimensions; Discrimination; Disruptive Behavior Disorder; Early Intervention; Enrollment; Event; Exposure to; Family; Feeling suicidal; Female; Foundations; Future; Genetic; Goals; Heart Diseases; Impairment; Individual; Life; Literature; Malignant Neoplasms; Manic; Mathematics; Medical; Mental Depression; Mental disorders; Modeling; Moods; Multicenter Studies; National Institute of Mental Health; Onset of illness; Outcome; Patients; Pharmaceutical Preparations; Phenotype; Population; Positioning Attribute; Predictive Factor; Prevention; Prognosis; Prognostic Factor; Provider; Psychopathology; Reporting; Research; Risk; Risk Estimate; Risk Factors; Sample Size; Sampling; Schizophrenia; Site; Specific qualifier value; Specificity; Substance Use Disorder; Substance abuse problem; Suicide; Symptoms; Time; To specify; Universities; Work; Youth; base; biological research; cardiometabolism; childhood bipolar disorder; clinical care; clinical practice; clinical risk; clinically relevant; cognitive control; cognitive function; cohort; comorbidity; depressive symptoms; dosage; early onset; emerging adult; flexibility; follow-up; human old age (65+); individualized medicine; inflammatory marker; minimal risk; mood symptom; neuroimaging; novel; outcome prediction; personalized management; personalized predictions; prospective; protective factors; psychosocial; recruit; sex; suicidal behavior; suicidal risk; tool

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.

项目摘要/摘要 小儿躁郁症（BP）的负面后果已充分记录，但是结果，结果， BP作为青年过渡到成年的预后因素仍然未知。要回答这些问题， 预测BP青年（Proby）的成人结果，这是一项多站点研究（匹兹堡大学，PI：B.Birmaher； 布朗大学，PIS：M.Keller/S.Yen；加州大学洛杉矶分校，PI：M.Strober），提案：1）扩展预期的随访 在成年期的双相青年（Coby）队列的课程和结果中，以及使用Coby Data进行 建立风险计算器，以预测短期（2年），中级（5年）和长期（10年）个性化 情绪课程/结果捕获了从青少年到成年的过渡。我们将学习五个钥匙 与BP相关的领域：1）情绪和非疾病的过程； 2）社会心理功能； 3） 自杀性； 4）SUD; 5）认知功能。风险计算是一种分析方法，而不是 小组预测，根据给定患者的特定事件的个性化估计值 存在多种危险因素。 Proby提出的风险计算器将对 预测BP结果，类似于心血管疾病和癌症的结果，但很少应用于 精神疾病。风险计算器将包括建立良好的变量，以允许复制 和临床实用程序。同样，这些变量在临床环境中很容易确定，并且是标准的一部分 练习，因此，将是可以广泛的分配，并在日常临床实践中坚定不移。为了 例如，结果可用于以下：咨询患者/家庭有关长期发病疗法的建议；个性化治疗 通过识别可能需要长时间治疗的患者，并且可以减少药物的患者 风险很小；并告知早期干预/预防以及临床/生物学研究。追求 拟议的研究，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％的高加索人，平均而言中产阶级）将进行另外2个临床评估 研究五年。这些受试者代表了2000年之间注册的原始样本（n = 446）的77％ 和2006年在三个研究地点。 Proby将继续前瞻性地收集有关分类和 维度心理病理学，受保护因素，社会心理功能（例如，关系，工作，学者）， 认知功能，炎症标记，心脏代谢状况，暴露于压力/创伤性生活 事件和治疗（例如，药物剂量，障碍）。还有5年的前瞻性观察， 样本的平均年龄将为31.3岁（23.7–38.7）。那将是首次研究 足够的样本量回答有关BP青年长大后会发生什么的问题。此外， Proby将是第一个建立风险计算器的研究，以预测与BP和BP相关的关键领域的结果 使用独立的成人BP样本（n = 427）从协作抑郁研究验证这些结果 （CDS; R01 MH025416）。这些风险计算器有可能广泛改变BP的临床护理。