Longitudinal Assessment of Manic Symptoms (LAMS) Study

描述（由申请人提供）：这一竞争性的继续申请要求资金在4个地点继续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症状升高（ESM）。大约621名青少年被确定患有ESM。此外，86名年龄/种族/性别匹配的首次临床表现无ESM的对照儿童被纳入研究。在LAMS研究期间，这些参与者在基线和之后每6个月进行一次评估。在每个评估点，对青少年的精神病学诊断、精神病学症状、精神卫生服务利用和心理社会功能进行评估。作为竞争持续申请（LAMS2）的一部分，研究人员建议继续进行6个月的评估。此外，LAMS2将包括神经认知测试和神经成像技术，以确定可能的生物标志物，这些生物标志物反映或与潜在的生物机制有关，这些机制使个体易患双相情感障碍。根据NIMH的战略计划，LAMS2将专注于检查和记录患有ESM和相关精神疾病的青少年的轨迹，以便更好地确定干预的关键时间点。更具体地说，LAMS2的目标包括：1)检查ESM随时间的稳定性与情绪症状变化和DSM-IV-TR情绪障碍标准的关系；2)检查ESM单独或与其他潜在危险因素联合的阳性预测价值，以便更好地识别在进入和度过青春期时最终将发展为双相情感障碍（BPD）的青少年；3)为双相情感障碍的儿童表型制定循证、理论性的诊断标准；4)识别与ESM青少年功能预后不良相关的危险因素；5)检查情绪发作与临床结果之间的关系；6)评估青少年和成年早期神经认知表现、部分神经系统功能异常及其与ESM和BPD发展的关系。目前的参与者将开始竞争性更新期，年龄从8-17岁不等。在2015年6月LAMS2结束时，队列的年龄将从13-22岁不等。因此，当研究参与者进入双相情感障碍发展的高风险年龄时，LAMS 2将为收集创新和临床重要数据提供机会。

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.