Phenomenology and Identification of Juvenile BPD in a Community Setting

CMHC中BPD的诊断通常具有挑战性。错误地将患者诊断为患有单极情绪障碍或 破坏性行为障碍导致次优结果，并可能使BPD的病程恶化。部分困难 目前对青少年BPD的现象学缺乏共识。而目前 也不确定BPD可能出现在CMHC的基本比率，也没有一套既定的 这些工具可用于筛选青少年社区样本的双相谱系障碍。考虑到长期的发展轨迹， 未经治疗或治疗不当的BPD的严重后果，以及早期干预和预防的潜在价值 如果能在年轻人中发现病例。该研究小组的初步证据表明， 在区分BPD与单相抑郁症，破坏性行为障碍和其他疾病方面表现良好， 儿童和青少年。然而，这些发现是基于一个在医院门诊的样本 在一个专门治疗青少年情绪障碍和精神药理学的学术医疗中心， research.因此，有几个因素阻碍了现有研究结果在社区环境中的直接应用， 包括社区精神卫生中心缺乏健全的BPD基本比率， 在心境障碍诊所与社区环境中，潜在确定偏倚的未知影响， 人口统计学或其他可能与测试性能相互作用的样本特征，以及测试 当从研究框架导出到社区环境中时，性能可能会降低， 治疗功效估计通常超过有效性发现。拟议项目的目的是 确定BPD在不同种族社区样本中的患病率，并制定有效的方法， 在CMHC中筛查双相谱系障碍的患者，以及提高对早期 双相谱系障碍的表现，特别是在服务不足的人群中。

The diagnosis of BPD in a CMHC is frequently challenging . Incorrectly diagnosing a patient as suffering from a unipolar mood disorder or from a disruptive behavior disorder leads to sub-optimal outcome and may worsen the course of BPD. Part of the difficulty is the current lack of consensus regarding the phenomenology of juvenile BPD. At present, there also is no certainty about the base rate at which BPD might present at a CMHC, nor is there an established set of instruments that could be used to screen a juvenile community sample for bipolar spectrum disorders. The need is great for such a screening protocol, given the long-term trajectory and serious consequences of untreated or mistreated BPD, and the potential value of early intervention and prophylaxis if cases could be identified in youths. Preliminary evidence from this research group suggests that several measures perform well at distinguishing BPD from unipolar depression, disruptive behavior disorders, and other disorders in children and adolescents. However, these findings were based on a sample presenting at a hospital outpatient clinic at an academic medical center 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 rates of BPD 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 project is to determine the prevalence of BPD in an ethnically diverse community sample and to develop effective means of screening patients in a CMHC for bipolar spectrum disorders, as well as to improve understanding of the early presentation of bipolar spectrum disorders, especially in underserved populations.