Longitudinal Assessment of Manic Symptoms (LAMS) Study

描述(由申请者提供)：这项竞争性的延续申请要求在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年里，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认为躁狂症状升高(ESM)。大约621名青年被确认患有ESM。另外，入选86名初诊时无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。在每个评估点，对青少年的精神诊断、精神症状、精神卫生服务利用情况和心理社会功能进行评估。作为竞争延续申请(LAMS2)的一部分，调查人员建议继续进行这些为期6个月的评估。此外，LAMS2将包括神经认知测试以及神经成像技术，以确定可能的生物标记物，这些生物标记物反映或与潜在的生物机制有关，这些机制使个人预先陷入双相情感障碍的发展。根据国家精神卫生研究所的战略计划，LAMS2将重点检查和记录患有ESM和相关精神障碍的青少年的轨迹，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与情绪症状和DSM-IV-TR情绪障碍标准随时间的变化的稳定性；2)单独检查ESM的阳性预测价值，并与其他潜在风险因素结合，以便更好地识别随着青春期的发展最终将发展为双相情感障碍(BPD)的年轻人；3)为双相情感障碍的儿科表型制定循证的、理论的诊断标准；4)确定与患有ESM的青少年功能结局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)评估神经认知表现，以及选定神经系统的功能异常，以及它们与ESM和BPD在青年和成年早期的发展的关系。目前的参与者将开始竞争更新期，年龄从8岁到17岁不等。到2015年6月LAMS2结束时，这群人的年龄将从13岁到22岁不等。因此，LAMS 2将在研究参与者进入发展双相情感障碍的高风险年龄的一段时间内提供收集创新和临床重要数据的机会。 公共卫生相关性：诊断青少年双相情感障碍(BPD)极具争议性。LAMS2的目标是：1)提高诊断的清晰度(即，根据经验界定谁符合诊断标准；为青年诊断标准制定循证指南)；2)提高对促使高危青年患或远离BPD的风险和保护因素的了解；3)提高对改善或削弱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BPD或没有BPD的青年中发生的结构和功能异常。

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.