Preschool Mood Disorders: Continuity and School Age Outcomes

描述（由申请人提供）：基于发育和探索性临床研究的发现，申请人的K08研究为特定和稳定的学龄前抑郁综合征提供了经验验证。应激皮质醇反应性的改变，以及负面情绪和快感缺乏的观察证据被发现，学前抑郁症的有效性提供了生物学和客观的证据。正在进行的R01旨在通过在一个大型社区研究人群中调查学龄前抑郁症的亚型和发展特征来推进这些发现，这些研究人群因情绪障碍而过度采样。NIMH补充剂使躁狂症状的探索性研究成为可能。在这个独立的样本中建立了验证学龄前抑郁症的研究结果的复制和扩展。此外，也出现了有效和强大的学龄前双相情感障碍的初步证据。正在进行的R01研究样本代表了迄今为止我们所知的最大的发展和诊断特征良好的情绪障碍学龄前儿童人群，为纵向随访提供了丰富的资源。本申请建议通过检查N=302名学龄前儿童的病程和特征，继续对学龄前情绪障碍进行调查，每年进行3次额外的诊断和发育评估。拟议的纵向研究将允许对情绪障碍进行首次调查，从其最早已知的学龄前时期的发作，到学龄后期的结果，与破坏性和健康的儿童进行比较。本研究旨在探讨发病年龄、亚型及情绪发展偏差对早发性心境障碍病程及转归的影响。虽然知道很多关于儿童后期情绪障碍的纵向过程中，有一个空白的数据库的连续性和调解结果从学龄前到学龄。这种发育转变对公共卫生至关重要，因为在更大的发育和神经生物学变化期间，这些慢性疾病有可能得到更早和更有效的干预。本研究样本包含高比例的学龄前儿童与情绪障碍和适当的控制提供了一个前所未有的机会，以弥合这一差距的经验数据库。研究结果将为未来情绪障碍早期干预试验的设计提供信息。

DESCRIPTION (provided by applicant): Building on findings from developmental and exploratory clinical studies, the applicant's K08 study provided empirical validation for a specific and stable preschool depressive syndrome. Alterations in stress cortisol reactivity, and observational evidence of negative affect and anhedonia were found, providing biological as well as objective evidence for the validity of preschool depression. The ongoing R01 aimed to advance these findings by investigating sub-types and developmental characteristics of preschool depression in a large community based study population, over-sampled for mood disorders. An exploratory investigation of mania symptoms was made possible by a NIMH supplement. Replication and extension of findings validating preschool depression were established in this independent sample. Further, preliminary evidence of a valid and robust preschool bipolar disorder also emerged. The ongoing R01 study sample represents the largest developmentally and diagnostically well-characterized population of mood-disordered preschoolers ascertained to date to our knowledge providing a rich resource for longitudinal follow-up. This application proposes to continue this investigation of preschool mood disorders by examining the course and characteristics of N=302 preschoolers for 3 additional diagnostic and developmental assessments annually through school age. The proposed longitudinal study will allow the first investigation of mood disorders, from their earliest known onset during the preschool period, to outcomes at late school- age, compared to disruptive and healthy children. This proposal aims to investigate the effect of age of onset, sub-type and deviations in emotional development on course and outcome of early onset mood disorders. While much is known about the longitudinal course of later childhood mood disorders, there is a gap in the database on the continuities and mediators of outcome from preschool to school age. This developmental transition is critically important to the public health because of the potential for earlier and more effective intervention in these chronic disorders during a period greater developmental and neurobiolgoical change. This study sample containing a high proportion of preschoolers with mood disorders and appropriate controls provides an unprecedented opportunity to bridge this gap in the empirical database. Findings would serve to inform the design of future early intervention trials for mood disorders.