Preschool Mood Disorders: Continuity and School Age Outcomes

描述（由申请人提供）：基于发展性和探索性临床研究的发现，申请人的K08研究为特异性和稳定的学龄前抑郁综合征提供了经验验证。发现应激皮质醇反应的改变，以及负面情绪和快感缺乏的观察证据，为学龄前抑郁症的有效性提供了生物学和客观证据。正在进行的R01旨在通过调查大型社区研究人群中学龄前抑郁症的亚型和发育特征来推进这些发现，过度采样的情绪障碍。通过NIMH的补充，对躁狂症状进行了探索性调查。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，初步证据的有效和健全的学前双相情感障碍也出现了。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育和诊断特征良好的情绪障碍学龄前儿童群体，为纵向随访提供了丰富的资源。本应用程序建议通过检查N=302名学龄前儿童的病程和特征，每年通过学龄进行3次额外的诊断和发展评估，继续对学龄前情绪障碍进行调查。拟议的纵向研究将允许对情绪障碍进行首次调查，从他们最早已知的学龄前发病到学龄后期的结果，将其与破坏性和健康儿童进行比较。本研究旨在探讨早发性情绪障碍的发病年龄、情绪发展的亚型和偏差对其病程和转归的影响。虽然我们对儿童后期情绪障碍的纵向病程了解甚多，但从学龄前到学龄期间，关于结果的连续性和中介因素的数据库仍存在空白。这种发育转变对公共卫生至关重要，因为在发育和神经生物学变化较大的时期，有可能对这些慢性疾病进行更早和更有效的干预。这项研究样本包含了高比例的学龄前儿童情绪障碍和适当的控制提供了一个前所未有的机会，以弥合这一差距在经验数据库。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.