Assessment of Juvenille Bipolar Spectrum Disorders

描述(由申请人提供)：双相情感障碍(BPSD)在社区精神卫生环境中经常被误诊，导致次优治疗选择，实际上可能会恶化疾病的进程。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在社区精神卫生环境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中的双相情感障碍。考虑到不治疗或虐待BPSD的长期轨迹和严重后果，以及如果能够发现青少年病例，早期干预的潜在价值，迫切需要这样的筛查方案。来自该研究小组的初步证据表明，有几种测量方法在区分BPSD与单相抑郁、破坏性行为障碍和儿童和青少年其他障碍方面表现良好(见附录)。然而，这些发现是基于在一家门诊研究诊所提交的样本，该诊所专门治疗青少年情绪障碍和精神药理学研究。因此，有几个因素阻碍了现有研究结果立即应用于社区环境，包括社区精神卫生中心缺乏可靠的BPSD基本比率，情绪障碍诊所相对于社区环境潜在的确证偏差的未知影响，人口统计学或其他可能与测试成绩相互作用的样本特征的变化，以及当从研究框架输出到社区环境时，测试成绩可能会下降的事实--就像治疗效果估计通常超过效果发现一样。拟议研究的目的是开发在社区精神健康环境中筛查双相情感障碍的有效手段，服务于种族和种族多样化的人口。这将通过确定社区样本中双相情感障碍的流行率，验证在学术临床环境中表现良好的措施，并澄清双相情感障碍的早期表现及其18个月的纵向病程的特征来实现。特别注意确定和确认患有双相症状的年轻人的诊断特征，这些症状不符合双相诊断的全部标准。这些儿童目前被标记为“双相情感障碍--没有特别说明”，他们可能是后来双相情感障碍的早期发育先兆，或者他们可能表现出发育不同的表现和过程。

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.