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 儿童双相情感障碍(BP)的负面后果是有据可查的，但其病程、结果、 随着青年过渡到成年，BP的预后因素仍不清楚。为了回答这些问题， 一项多点研究(匹兹堡大学，PI：B.Birmaher； 布朗大学，PI：M.Keller/S.Yen；UCLA，PI：M.Strober)，建议：1)延长预期随访 双相青年(Coby)队列进入成年期的过程和结果；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)的个性化 情绪过程/结果捕捉从青春期到成年期的过渡。我们将研究五个关键 与BP相关的领域：1)情绪和非情绪障碍的病程；2)心理社会功能；3) 自杀；4)自闭症；5)认知功能。风险计算是一种分析方法，而不是 分组预测，根据特定事件对特定患者的风险进行个性化估计 存在多种风险因素。Proby中提出的风险计算器将在以下方面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的方法，但很少用于 精神障碍。风险计算器将包括公认的变量，以便进行复制 和临床实用价值。此外，这些变量很容易在临床环境中确定，并且是标准的一部分 因此，实践将被广泛传播，并有望在日常临床实践中发挥作用。为 例如，结果可用于：就长期预后向患者/家属提供咨询；个体化治疗 通过确定可能需要延长治疗的患者和可能减少药物治疗的患者 将风险降至最低；并为早期干预/预防和临床/生物研究提供信息。为了追求 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)岁， 47%的女性，82%的高加索人，平均而言，中产阶级)将有两次额外的临床评估 五年的学习。这些受试者占2000年间登记的原始样本(n=446)的77% 和2006年在这三个研究地点。Proby将继续前瞻性地收集关于分类和 次元精神病理学、保护性因素、心理社会功能(例如，关系、工作、学术)， 认知功能、炎症标志物、心脏代谢状况、暴露在紧张/创伤的生活中 事件和治疗(例如，用药剂量、障碍)。再加上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将是第一个 足够的样本量来回答有关BP年轻人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来预测与BP和 使用来自协作性抑郁研究的独立成人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。