The Characterization And Treatment Of Children With Seve

最近，研究人员和临床医生将更多的注意力集中在一群患有严重情绪和行为失调的儿童身上。这些儿童的特点是损害症状，包括异常的基线情绪（如烦躁、愤怒和/或悲伤）、过度觉醒（如失眠、躁动、注意力不集中）和对负面情绪刺激的反应增加。由于这种综合征与双相情感障碍（BPD）有许多共同的临床特征，对于这些儿童是否应该被诊断为BPD存在相当大的争论。然而，患有该综合征的儿童缺乏BPD的主要症状，并且其他DSM-IV的诊断（ADHD， ODD等）捕获了异质性的临床人群，其中包括许多没有表现出上述症状的儿童。因此，本项目的目标是：1)可靠地识别一组患有严重情绪和行为失调的儿童，以便对他们进行临床表征并进行纵向跟踪；2)在该人群中开展锂的双盲、安慰剂对照试验；3)研究与双相情感障碍患者神经营养效应和磷酸肌肽信号变化相关的锂反应是否在该组患者中具有类似的效果。标准化的访谈模块和评定量表将被用来评定情绪失调的临床特征。进行锂离子双盲、安慰剂对照试验，治疗前后分别进行磁共振波谱（MRS）测定NAA和mI。大约有10名患者完成了治疗试验，并获得了MRS扫描。此外，从成人和儿童的对照样本中获得了MRS扫描和神经心理学测试数据，以使我们能够建立神经化学的发育规范，并探索NAA水平与前额皮质功能测试之间的关系。最后，我们与国家儿童医疗中心建立了合作关系，使我们能够在三级保健儿童精神病诊所的环境中应用标准化的工具，以确定患有严重情绪失调的儿童的特征。

Recently, researchers and clinicians have focused increased attention on a group of children with severe mood and behavioral dysregulation. These children are characterized by impairing symptoms that include abnormal baseline mood (i.e. irritability, anger, and/or sadness), hyperarousal (e.g. insomnia, agitation, distractibility), and increased reactivity to negative emotional stimuli. Because this syndrome shares many clinical features with bipolar disorder (BPD), there is considerable debate as to whether these children should be diagnosed with BPD. However, children with this syndrome lack the cardinal symptoms of BPD, and other DSM-IV diagnoses (ADHD, ODD, etc.) capture heterogeneous clinical populations that include many children who do not exhibit the symptoms noted above. Therefore, the goals of this project are 1) to identify reliably a group of children with severe mood and behavioral dysregulation in order to characterize them clinically and follow them longitudinally; 2) to conduct a double-blinded, placebo-controlled trial of lithium in this population; and 3) investigate whether lithium response, which has been associated with neurotrophic effects and with changes in phosphoinositide signaling in bipolar patients, has similar effects in this group of patients. Standardized interview modules and rating scales will be used to rate the clinical features of mood dysregulation. A double-blind, placebo-controlled trial of lithium will be conducted, and magnetic resonance spectroscopy (MRS) to measure NAA and mI will be preformed before and after treatment. Approximately 10 patients have completed the treatment trial, and MRS scans have been obtained. In addition, MRS scans and neuropsychological test data are being acquired from a sample of control adults and children to allow us to establish developmental norms for neurochemistry, and to explore associations between NAA levels and tests of prefrontal cortical function. Finally, a collaboration with Children's National Medical Center has been established in order to allow us to apply, in the setting of a tertiary care child psychiatric clinic, standardized instruments designed to characterize children with severe mood dysregulation.