Assessment of Juvenille Bipolar Spectrum Disorders

描述（由申请人提供）：双相情感障碍（BPSD）在社区精神卫生机构中经常被误诊，导致不理想的治疗选择，这实际上会使疾病的病程恶化。诊断困难的部分原因是目前对青少年BPSD的现象学缺乏共识。目前，BPSD在社区精神卫生机构中可能出现的基本比率也不确定，也没有一套既定的工具可用于筛查青少年社区样本的双相情感障碍。考虑到未经治疗或虐待的BPSD的长期发展轨迹和严重后果，以及如果能够识别青少年病例，早期干预的潜在价值，这种筛查方案是非常需要的。该研究小组的初步证据表明，有几种方法可以很好地将BPSD与单极抑郁症、破坏性行为障碍以及儿童和青少年的其他疾病区分开来（见附录）。然而，这些发现是基于在一家专门从事青少年情绪障碍治疗和精神药理学研究的门诊研究诊所提供的样本。因此，有几个因素阻碍了现有研究结果在社区环境中的立即应用，包括社区精神卫生中心缺乏健全的BPSD基本比率，情绪障碍诊所与社区环境潜在的确定偏差的未知影响，人口统计学的变化或其他可能与测试表现相互作用的样本特征，事实上，当从研究框架导出到社区环境中时，测试的表现可能会下降——就像治疗效果估计通常超过有效性发现一样。提出的研究的目的是发展有效的手段筛选双相情感障碍在社区精神卫生机构服务于民族和种族多样化的人群。这将通过确定社区样本中双相情感障碍的患病率，验证在学术临床环境中表现良好的措施，并阐明双相情感障碍早期表现的特征及其超过18个月的纵向病程来实现。特别注意的是识别和验证青年双相情感障碍症状的诊断特征，不符合双相情感障碍诊断的全部标准。这些儿童，目前被标记为“双相情感障碍-未另行说明”，可能代表后期双相情感障碍的早期发展前兆，或者他们可能表现出不同的发展表现和过程。

DESCRIPTION (provided by applicant): Bipolar spectrum disorders (BPSD) are commonly misdiagnosed in community mental health settings, resulting in suboptimal treatment selection that can actually worsen the course of the disorder. Part of the difficulty in diagnosis is the current lack of consensus about the phenomenology of juvenile BPSD. At present, there also is no certainty about the base rate at which BPSD might present at a community mental health setting, nor is there an established set of instruments that could be used to screen a juvenile community sample for bipolar spectrum disorders. Such a screening protocol is sorely needed, given the long-term trajectory and serious consequences of untreated or mistreated BPSD, and the potential value of early intervention if juvenile cases could be identified. Preliminary evidence from this research group suggests that several measures perform well at distinguishing BPSD from unipolar depression, disruptive behavior disorders, and other disorders in children and adolescents (see Appendices). However, these findings were based on a sample presenting at an outpatient research clinic specializing in the treatment of juvenile mood disorders and psychopharmacology research. Thus, several factors prevent the immediate application of existing findings to a community setting, including the lack of soundly-established base rate of BPSD at community- based mental health centers, the unknown effects of potential ascertainment bias at a mood disorders clinic versus a community setting, changes in demographics or other sample characteristics that might interact with test performance, and the fact that test performance might degrade when exported from a research framework into a community context - much as therapeutic efficacy estimates usually exceed effectiveness findings. The purpose of the proposed study is to develop effective means of screening for bipolar spectrum disorders in a community mental health setting serving an ethnically and racially diverse population. This will be accomplished by determining the prevalence of bipolar disorders in a community sample, validating measures that have performed well in an academic clinical setting, and clarifying the features of early presentation of bipolar spectrum disorders along with their longitudinal course over 18 months. Particular attention is paid to identifying and validating diagnostic characteristics of youths with bipolar symptoms that do not meet full criteria for a bipolar diagnosis. These children, currently labeled "Bipolar- Not Otherwise Specified", may represent an early developmental precursor of later bipolar disorder, or they may manifest a developmentally different presentation and course.