U of Cincinnati Bipolar Disorder Imaging & Treatment Research Center (BITREC)

双相情感障碍是一种动态的、进行性的疾病，其治疗决定是根据经验做出的。神经成像帮助定义了双相情感障碍的神经生理模型，这些模型通过识别治疗反应和疾病进展的标记和预测因子，有望改善治疗分配。我们建议加州大学双相情感障碍成像和治疗研究中心(BITREC)来实现这一承诺。指导这个中心的总体假设和组织主题是，双相情感障碍是由特定大脑系统(即前缘网络)内的大脑新陈代谢障碍引起的，该系统可以 使用磁共振成像(MRI)和波谱(MRS)对治疗反应进行监测。在这个中心，我们将把MRI和MRS与结果测量和治疗试验相结合，以开发双相情感障碍早期治疗反应的特定神经生理学模型。这些模型将提供识别治疗反应的标志物和预测因素的手段，以个体化用药处方，从而将情感复发降至最低，防止疾病进展，并改善长期病程。为了实现我们的目标，我们将整合我们丰富的先前经验和现有资源，创建具体的研究和管理核心；这些核心将用于建立BITREC基础设施。有了这一基础设施，我们将招募病程早期(在疾病显著进展之前)的大样本双相情感障碍患者，以及一批高危受试者(没有双相情感障碍但父母为双相情感障碍的青少年)。这些受试者将被要求参与结合MRI、MRS、治疗和临床结果的具体项目，以完善双相情感障碍的现有神经生理学模型。我们将使用这些模型来 确定治疗反应的特定神经生理学标志物，以阐明不同药物对双相神经生理学的影响。然后，我们将使用这些标记物来开发双相情感障碍治疗反应和疾病进展的特定神经生理学预测因子。最后，我们将把这些模型应用于高危患者(在出现第一次躁狂发作之前)，以预防或推迟双相情感障碍的发病。

Bipolar disorder is a dynamic, progressive illness in which treatment decisions are made empirically. Neuroimaging has helped to define neurophysiological models of bipolar disorder that offer the promise of improving treatment assignment by identifying markers and predictors of treatment response and disease progression. We propose the UC Bipolar Disorder Imaging & Treatment Research Center (BITREC) to meet this promise. The overall hypothesis and organizing theme guiding this center is that bipolar disorder results from dysfunctional brain metabolism within specific brain systems (i.e., the anterior limbic network) that can be monitored in response to treatments using magnetic resonance imaging (MRI) and spectroscopy (MRS). In this center, we will integrate MRI and MRS with outcome measures and treatment trials in order to develop specific neurophysiological models of treatment response early in the course of bipolar disorder. These models will provide the means to identify markers and predictors of treatment response to individualize medication prescription, thereby minimizing affective recurrences, preventing disease progression, and improving long-term course of illness. In order to achieve our goals, we will integrate our extensive prior experience and current resources to create specific research and administrative cores; these cores will be used to establish the BITREC infrastructure. With this infrastructure in place, we will recruit a large sample of bipolar patients early in the course of illness (prior to significant illness progression), as well as a cohort of at-risk subjects (adolescents without bipolar disorder, but with bipolar parents). These subjects will be asked to participate in specific projects integrating MRI, MRS, treatment and clinical outcome in order to refine existing models of the neurophysiology of bipolar disorder. We will use these models in order to identify specific neurophysiological markers of treatment response in order to clarify the effects that different medications have on bipolar neurophysiology. We will then use these markers to develop specific neurophysiological predictors of treatment response and illness progression in bipolar disorder. Finally, we will apply these models to at-risk patients (prior to developing a first manic episode) in order to prevent or delay the onset of bipolar disorder.