Early Assessment and Intervention for Adolescents at Risk for Bipolar Disorder

描述（由申请人提供）：发展为双相情感障碍（BP）最有效的危险因素是患有该疾病的一级家庭成员。因此，父母患有BP的后代是一个特别的高风险群体，通常会经历发病早、病程严重和高发生率的共病精神障碍。众所周知，在对情绪障碍有生理脆弱性的个体中，睡眠调节不良与抑郁和躁狂发作有关。此外，有证据支持睡眠障碍存在于尚未出现阈值情绪障碍的高危青少年中。我们提出的研究旨在解决这一核心问题，我们认为这一问题使高危青少年面临更大的bp睡眠和社交节奏中断的风险。由于青春期是睡眠/觉醒模式和社交习惯发生重大变化的时期，这一时期可能是评估和治疗高危人群睡眠和精神症状的最佳时期。我们对人际和社会节律疗法（IPSRT）进行了调整和试点，这是一种经验支持的治疗成人BP的方法，可以帮助患者稳定睡眠/觉醒周期和日常生活，适用于高危青少年。初步数据表明，这种方法对有BP发展风险的青少年有希望。我们还确定了对高血压发生前异质性条件的干预，作为预防或延迟高危青少年高血压发病的第二途径。因此，本研究的目的是进一步发展和检验IPSRT对BP父母的青少年（12-18岁）后代的影响。该研究包括进行一项小型对照试验（n=50），比较简短IPSRT +数据知情转诊与单独数据知情转诊，以收集与干预相关的可行性、可接受性和近端结果的初步数据。在基线时，所有参与者都接受全面的精神病理学和睡眠障碍评估（通过客观和主观方法），随后进行一次评估结果的反馈会议。根据临床指示，将为在摄入评估期间发现的任何精神症状/障碍提供数据知情转诊。然后，青少年将随机接受简短的IPSRT或不接受简短的IPSRT；随机分组将根据睡眠障碍和精神病理进行分层。所有参与者将在6个月内的4个时间点评估结果。数据将用于未来对照试验的设计和实施。拟议的方法与NIMH战略计划中概述的战略直接一致，在该战略计划中，开发和测试创新干预措施，以减少风险并积极改变精神疾病的轨迹，这是根据有关强大和可延展性风险因素和疾病核心特征的研究结果提供的信息。这一领域的研究具有重大的公共卫生重要性，因为它有可能预防、延缓或改善这一慢性和毁灭性疾病在高危人群中的进展。

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.