Early Assessment and Intervention for Adolescents at Risk for Bipolar Disorder

描述(由申请人提供)：患双相情感障碍(BP)的最大风险因素是患有这种疾病的一级家庭成员。因此，患有BP的父母的子女是一个特别高风险的群体，通常会经历早期发病、严重病程和高比例的共病精神障碍。众所周知，睡眠调节不良与在生理上易患情绪障碍的人中抑郁和躁狂发作有关。此外，有证据支持尚未发展为情绪障碍的高危青少年存在睡眠障碍。这项拟议的研究旨在解决这种核心干扰，我们认为这种干扰会使处于危险中的年轻人面临更大的BP-睡眠和社交节奏紊乱的风险。由于青春期是睡眠/醒来模式和社交习惯发生重大变化的时期，这一时期可能被证明是评估和治疗高危人群睡眠和精神症状的最佳时期。我们调整和试点了人际和社会节奏疗法(IPSRT)，这是一种针对成人BP的经验性治疗，帮助患者稳定睡眠/醒来周期和高危青少年的日常生活。初步数据表明，这种方法对于BP发展的高危青年来说是有希望的。我们还确定了对BP前的异质性疾病的干预是预防或延迟高危青年BP发病的第二条途径。因此，拟议研究的目的是进一步发展和检查患有BP的父母的青少年(12-18岁)子女的IPSRT。这项研究包括进行一项小型对照试验(n=50)，比较简短的IPSRT+数据信息转介和单独数据信息转介，以收集与干预相关的可行性、可接受性和近期结果的初步数据。所有参与者都会在基线上接受一次彻底的精神病理学和睡眠障碍评估(通过客观和主观方法)，然后进行一次单一的反馈会议，审查结果。正如临床上所指出的，将向青少年提供数据信息转介，以了解在收容评估期间发现的任何精神症状/障碍。然后，青少年将被随机分为接受短暂的IPSRT或不接受短暂的IPSRT；随机分组将根据睡眠障碍和精神病理学进行分层。所有参与者将在6个月内的4个时间点对结果进行评估。数据将被用来为未来对照试验的设计和实施提供信息。拟议的方法与NIMH战略计划中概述的战略直接一致，根据该战略计划，开发和测试创新干预措施以降低风险并积极改变精神疾病的发展轨迹，是基于关于强健和可延展的风险因素和疾病核心特征的研究结果。这一领域的研究对公共卫生具有重大意义，因为它有可能预防、推迟或改善高风险人群这种慢性和破坏性疾病的进展。

DESCRIPTION (provided by applicant): The most potent risk factor for the development of bipolar disorder (BP) is a first-degree family member with the illness. Thus, offspring of parents with BP are a particularly high-risk group and typically experience early illness onset, severe course, and high rates of comorbid psychiatric disorders. It is well-established that poor sleep regulation is associated with the onset of depressive and manic episodes among individuals with a biological vulnerability to mood disorder. Furthermore, evidence supports sleep disturbance in at-risk youth who have not yet developed threshold mood disorders. The proposed study aims to address this core disturbance that we argue puts at-risk youth at even greater risk for development of BP-sleep and social rhythm disruption. Since adolescence is a period characterized by significant alterations in sleep/wake patterns and social routines, this period may prove optimal for assessment and treatment of sleep and psychiatric symptoms in those at-risk. We adapted and piloted Interpersonal and Social Rhythm Therapy (IPSRT), an empirically-supported treatment for adults with BP that helps patients stabilize sleep/wake cycles and daily routines, for at-risk adolescents. Preliminary data indicate this approach holds promise as for youth at-risk for the development of BP. We also identified intervention for the heterogeneous conditions antecedent to BP as a second path to preventing or delaying BP onset in at-risk youth. The purpose of the proposed study is thus to further develop and examine IPSRT for the adolescent (age 12-18) offspring of parents with BP. The study involves conduct of a small controlled trial (n=50) comparing Brief IPSRT + Data-Informed Referral versus Data-Informed Referral alone to gather preliminary data on feasibility, acceptability and proximal outcomes associated with the intervention. All participants receive a thorough assessment of psychopathology and sleep disturbance (via objective and subjective methods) at baseline, followed by a single feedback session reviewing the findings. As clinically indicated, youth will be offered Data-Informed Referral for any psychiatric symptoms/disorders identified during the intake assessment. Youth will then be randomized to receive either Brief IPSRT or no Brief IPSRT; randomization will be stratified on sleep disturbance and psychopathology. Outcomes will be assessed at 4 time points over 6 months in all participants. Data will be used to inform the design and conduct of a future controlled trial. The proposed approach is in direct accord with strategies outlined in the NIMH Strategic Plan in which the development and testing of innovative interventions to reduce risk and positively alter trajectories of mental illness are informed by research findings regarding robust and malleable risk factors and core features of disease. Research in this area is of great public health importance, as it has the potential to prevent, delay, or ameliorate the progression of this chronic and devastating illness in those at highest risk.