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Understanding/ Treating Neuropsychiatric Symptoms of Pediatric Physical Illness

了解/治疗小儿身体疾病的神经精神症状

基本信息

批准号：
7934858
负责人：
EVA M SZIGETHY
金额：
$ 10万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-30 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7934858
关键词：
Abdominal Pain Academy Accident and Emergency department Accounting Acquired Immunodeficiency Syndrome Acute Adolescence Adolescent Adolescent Development Adolescent Psychiatry Adult Adverse effects Affect Affective Aftercare Age Albumins Algorithms American Amygdaloid structure Analgesics Angiotensin Receptor Anhedonia Animals Antidepressive Agents Anxiety Appointment Area Arts Asthma Attention Autoimmune Diseases Autoimmune Process Autonomic nervous system Award Basal Nucleus of Meynert Base of the Brain Basic Science Behavior Behavior Therapy Behavioral Behavioral Paradigm Belief Biochemical Biological Biological Sciences Biopsy Blood Boston Brain Brain Stem Brain imaging Brain region C-reactive protein Caliber Canis familiaris Caring Categories Cell Nucleus Characteristics Charge Chest Child Child Care Childhood Cholecystokinin Chronic Chronic Childhood Arthritis Chronic Disease Circadian Rhythms Cities Classification Clinic Clinical Clinical Data Clinical Sciences Clinical Trials Cognition Cognitive Cognitive deficits Collaborations Colonoscopy Communication Communities Comorbidity Complex Computer software Computers Conflict (Psychology)Consult Control Groups Coping Skills Cosmetics Coupling Crohn&apos s disease Cross-Sectional Studies Cues Cultural Backgrounds DNA DSM-IV Data Data Analyses Depressed mood Depressive disorder Desire for food Development Devices Diagnosis Discipline Disease Disease remission Doctor of Philosophy Dopamine Dose Economics Educational process of instructing Effectiveness Electrons Emotional Emotions Empathy Endogenous depression Enrollment Environment Environmental Risk Factor Equation Equilibrium Equipment and supply inventories Erythrocyte Sedimentation Rate Etiology Evaluation Event Exclusion Criteria Exhibits Exposure to Eye Face Facilities and Administrative Costs Family Fatigue Feeling Female Fistula Flare Foundations Frequencies Functional Imaging Functional Magnetic Resonance Imaging Functional disorder Future Gastroenterology Gastrointestinal tract structure Gender Generations Genetic Genotype Glucocorticoids Goals Grant Grant Review Process Growth Head Health Health Care Costs Health Services Health Status Heart Heart Diseases Heart Rate Hematocrit procedure Hemorrhage Hepatology Heterogeneity Hippocampus (Brain)Hospitalization Hour Human Hungary Hydrocortisone Image Immune Immune System and Related Disorders Immunology Impaired cognition Impairment Individual Inflammation Inflammatory Inflammatory Bowel Diseases Inflammatory Response Inpatients Institutes Interferons Interleukin-10 Interleukin-12 Interleukin-2 Interleukin-6 Intervention Interview Intestines Investigation Journals K-Series Research Career Programs Knowledge Laboratories Learning Length of Stay Leukocytes Life Linear Models Link Literature Location Logistics Magnetic Resonance Imaging Maintenance Major Depressive Disorder Malignant Neoplasms Manuals Masks Master&apos s Degree Measurement Measures Mediating Mediation Mediator of activation protein Medical Medical History Medical Records Medical center Medicine Memory Mentorship Meta-Analysis Metabolism Microscopic Modeling Modification Mood Disorders Moods Morbidity - disease rate Mutation Mydriasis National Institute of Mental Health Neuroanatomy Neurobiology Neurologic Neuronal Plasticity Neuropeptides Neurosciences Neurotensin Neurotransmitters Nucleus Accumbens Operative Surgical Procedures Outcome Outpatients Pain Parents Participant Pathway interactions Patients Pattern Pediatric Hospitals Peripheral Persons Pharmaceutical Preparations Pharmacotherapy Phenotype Physiologic Monitoring Physiologic pulse Physiological Pilot Projects Play Population Prednisone Prefrontal Cortex Pregnancy Tests Prevalence Prevention Prize Probability Procedures Process Proteins Provider Proxy Psychiatric Diagnosis Psychiatric therapeutic procedure Psychiatrist Psychiatry Psychological reinforcement Psychology Psychopathology Psychopharmacology Psychosocial Factor Puberty Public Health Publications Pupil Quality of life Questionnaires Randomized Randomized Controlled Trials Recovery Recruitment Activity Regulation Relative (related person)Relaxation Reporting Research Research Design Research Infrastructure Research Personnel Respiration Rest Rewards Risk Role Running Sample Size Sampling Savings Scanning Science Scientist Screening procedure Secondary to Selective Serotonin Reuptake Inhibitor Series Severities Severity of illness Short-Term Memory Sickle Cell Anemia Silk Site Sleep Sleep Deprivation Sleep disturbances Sleeplessness Slice Social Functioning Social support Socialization Societies Sodium Chloride Specificity Staging Steroids Stigmata Stimulus Stratification Stress Structural Models Structure Substantia nigra structure Supervision Supportive care Surrogate Markers Susceptibility Gene Symptoms Synapses System Teaching Materials Techniques Technology Teenagers Telephone Testing Therapeutic Therapeutic Effect Time Training Translating Translational Research Transportation Treatment Cost Ulcerative Colitis United States National Institutes of Health Universities Upper arm Urine Utah Variant Visit Weight Well in self Work Writing Youth abstracting active control auditory stimulus base behavioral health behavioral/social science body system brain metabolism brief intervention career child depression cholinergic neuron chronic pain clinical care clinically relevant clinically significant cognitive behavior therapy cognitive change cognitive function cohort collaborative care combat comparative efficacy comparison group computer generated conditioning coping cost cost effective cost effectiveness critical developmental period cytokine data modeling depressed depression depressive symptoms design deviant dietary restriction disease diagnosis dopaminergic neuron economic cost effective therapy executive function experience flexibility follow-up functional loss gastrointestinal system genetic risk factor graduate student group intervention health economics health related quality of life high risk hypertension control illness perceptions immune function improved indexing inflammatory marker information processing innovation interest intervention effect longitudinal course man medical schools medication compliance meetings mortality neurobehavioral neurodevelopment neuroimaging neuronal cell body neurophysiology neuropsychiatry neurotoxicity novel nutrition physical conditioning prevent programs prospective prototype psychoeducation psychosocial receptor reinforced behavior relating to nervous system response skills skills training social skills social stigma software development stem tertiary care theories therapy adherence therapy design time use translational neuroscience treatment as usual treatment effect treatment response treatment strategy virtual reality visual stimulus way finding willingness

项目摘要

Abstract Depression is costly and has detrimental effects on disease course in physically ill populations. This proposal takes a novel multi-dimensional approach to assess the neurobiological basis of depression in chronic pediatric physical illness using inflammatory bowel disease (IBD) as a model. It also evaluates the efficacy of a modified cognitive behavioral therapy (CBT) on emotional well-being, physical health, economic costs, and neurobiological outcomes. These results will provide key building blocks for a paradigm shift within medicine by integrating behavioral health into the comprehensive medical care of physical illnesses. Little is known about how the brain and body interact to increase depressive vulnerability, particularly during key developmental periods during childhood and adolescence. Adult studies identify disruptions in limbic and prefrontal brain activity in the pathophysiology of depression. Cytokines secondary to inflammation and exogenous treatment with steroids can cause mood and cognitive changes in these same brain regions. It is important to understand the neuropsychiatric effects of IBD and its treatment on underlying brain structures during adolescence, a critical developmental period for brain maturation underlying emotional regulation and cognitive processing. More importantly, neuronal plasticity during adolescence may still allow reversibility of disease-related brain effects through teaching coping strategies for life-long illness management that could change developmental trajectories and reduce vulnerability in adulthood. Using translational neuroscience approaches, this proposal will examine: 1) brain regions that underlie emotional and cognitive processing in youth with active IBD and depression using brain functional magnetic resonance imaging compared to youth with IBD and no depression, and normal controls; and 2) the efficacy of a combined CBT-physical illness narrative intervention targeting emotional and cognitive processing compared to supportive non-directive therapy at: (a) improving emotional well being; (b) alleviating physical symptoms; and (c) reducing health care costs.

摘要抑郁症的成本很高，而且对身体不好的人群的病程有不利影响。这 Proposal采用了一种新的多维方法来评估抑郁症的神经生物学基础以炎症性肠病(IBD)为模型的儿科慢性躯体疾病。它还评估改良认知行为疗法(CBT)对情绪、身体健康、经济的疗效成本和神经生物学结果。这些结果将为以下领域的范式转变提供关键的构建块将行为健康融入到身体疾病的综合医疗保健中的医学。关于大脑和身体如何相互作用增加抑郁的易感性，尤其是在儿童和青春期的关键发育阶段。成人研究发现边缘和大脑边缘的紊乱前额叶脑活动在抑郁症病理生理学中的作用继发性炎症和细胞因子使用类固醇的外源性治疗会导致这些大脑区域的情绪和认知变化。它是了解IBD及其治疗对潜在脑结构的神经精神影响很重要青春期是大脑成熟的关键发育期，情绪调节和认知加工。更重要的是，青春期神经元的可塑性可能仍然允许可逆性通过教授终身疾病管理的应对策略来实现与疾病相关的大脑影响改变发育轨迹，减少成年后的脆弱性。使用翻译神经科学的方法，这项提议将检查：1)大脑的基础区域应用脑功能磁学研究青少年活动期IBD和抑郁症患者的情绪和认知加工磁共振成像与患有IBD且无抑郁的青年和正常对照组进行比较；以及2)对以情绪和认知加工为目标的CBT-躯体疾病叙事干预研究非指导性支持性治疗：(A)改善情绪；(B)缓解躯体症状；以及(C)降低医疗费用。