Longitudinal Assessment of Manic Symptoms (LAMS) Study

描述（由申请人提供）：此竞争性继续申请要求资金继续在4个地点进行躁狂症状纵向评估（LAMS）研究。在过去的3.5年中，使用有效和可靠的筛查工具，6-12岁的儿童在首次临床表现时被确定为躁狂症状（ESM）升高。约有621名青年被确定患有无害环境管理。此外，入组了86例首次临床表现时无ESM的年龄/种族/性别匹配的对照儿童。在LAMS研究期间，这些参与者在基线和此后每6个月进行一次评估。在每一个评估点，青少年进行了评估，他们的精神病诊断，精神病学，精神卫生服务的利用，和心理社会功能。作为该竞争性继续申请（LAMS 2）的一部分，研究者建议继续进行这些6个月的评价。此外，LAMS 2将包括神经认知测试以及神经影像学技术，以确定可能的生物标志物，这些生物标志物反映了使个体易患双相情感障碍的潜在生物学机制或与之相关。 根据国家精神卫生研究所的战略计划，LAMS 2将侧重于检查和记录患有ESM和相关精神疾病的青年的轨迹，以便更好地确定干预的关键时间点。更具体地说，LAMS 2的目标包括：1）检查ESM随时间变化的稳定性与情绪症状和DSM-IV-TR情绪障碍标准的变化; 2）检查ESM单独和与其他潜在风险因素组合的阳性预测值，以便更好地识别随着进入青春期和青春期最终发展为双相情感障碍（BPD）的青少年; 3）为双相谱系障碍的儿科表型制定循证的、非理论的诊断标准; 4）确定与ESM青少年功能结局不良相关的风险因素; 5）检查情绪发作与临床结局之间的关系; 6）评估神经认知性能，以及选定的神经系统功能异常及其与ESM的关系以及青年和成年早期BPD的发展。目前的参与者将开始竞争性续约期，年龄从8岁到17岁不等。在LAMS 2（2015年6月）结束时，该队列的年龄范围为13-22岁。因此，LAMS 2将为在研究受试者进入双相谱系障碍发展高风险年龄期间收集创新和临床重要数据提供机会。 公共卫生相关性：诊断青少年双相情感障碍（BPD）是非常有争议的。LAMS 2的目标是：1）提高诊断的清晰度（即，经验性地描述谁符合诊断标准，谁不符合诊断标准; 2）为青年诊断标准制定循证指南; 2）提高对推动高危青年进入或远离发展BPD的风险和保护因素的理解; 3）提高对改善或减损这些青年功能结果的风险和保护因素的认识; 4）了解随着时间的推移，发生在青少年中的结构和功能性大脑异常，而不是发展BPD。

DESCRIPTION (provided by applicant): This competing continuation application requests funds to continue the Longitudinal Assessment of Manic Symptoms (LAMS) study at 4-sites. Over the past 3.5 years, using a valid and reliable screening instrument, children ages 6-12 years were identified with elevated symptoms of mania (ESM) at the time of their first clinical presentation. Approximately 621 youth were identified as having ESM. In addtion, 86 age/race/sex matched comparison children without ESM at first clinical presentation were enrolled. During the LAMS study, these participants were evaluated at baseline and every 6 months thereafter. At each assessment point, youths were evaluated regarding their psychiatric diagnoses, psychiatric symptomatology, mental health service utilization, and psychosocial functioning. As part of this competing continuation application (LAMS2), the investigators propose to continue these 6-month evaluations. In addition, LAMS2 will include both neurocognitive testing as well as neuroimaging techniques in order to identify possible biomarkers that reflect or are related to underlying biological mechanisms that predisopose individuals to the development of bipolar disorders. In acordance with the NIMH's Strategic Plan, LAMS2 would focus on examining and documenting trajectories of youths with ESM and related psychiatric disorders in order to better identify crucial timepoints for intervention. More specifically, the goals of LAMS2 include: 1) examining the stability of ESM over time in relation to changes in mood symptoms and DSM-IV-TR criteria for mood disorders; 2) examining the positive predictive value of ESM alone and in combination with other potential risk factors in order to better identify youth who will eventually develop bipolar disorders (BPD) as they progress into and through adolescence; 3) developing evidence-based, atheoretical, diagnostic criteria for a pediatric phenotype for bipolar spectrum disorders; 4) identifying risk factors associated with poor functional outcomes for youth with ESM; 5) examining the relationships between mood episodes and clinical outcomes over time; 6) evaluating neurocognitive performance, together with functional abnormalities in selected neural systems and their relationship to ESM and the development of BPD during youth and early adulthood. The current participants will begin the competitive renewal period ranging in age from 8-17 years. At the end of LAMS2, June 2015, the cohort will range in years from 13-22 years. For this reason, LAMS 2 will provide an opportunity for the collection of innovative and clinically important data during a period of time in which when study participants will have entered an age of high risk for the development of a bipolar spectrum disorder. PUBLIC HEALTH RELEVANCE: Diagnosing bipolar disorders (BPD) in youth is highly controversial. Goals of LAMS2 are to: 1) increase clarity of diagnosis (i.e., empirically delineate who does versus does not meet diagnostic criteria; develop evidence-based guidelines for diagnostic criteria in youth); 2) improve understanding of risk and protective factors that propel high-risk youth into, or away from developing BPD; 3) increase awareness of risk and protective factors that improve or detract from functional outcome for these youth; 4) learn about the structural and functional brain abnormalities that occur in youth who do, versus do not, develop BPD over time.