Adolescents at High Risk for Familial Bipolar Disorder

描述（由申请人提供）：双相情感障碍是一种严重的遗传性精神疾病，影响总人口的1%。发病年龄一般在青少年晚期或成年早期。对影响这种疾病的发病率和发病年龄的具体危险因素知之甚少。1988年，NIMH建立了双相情感障碍遗传学倡议，目标是确定易感基因；这项合作已经确定了数百个有双相情感障碍的家庭。作为最初的3个合作站点（印第安纳大学、约翰霍普金斯大学和圣路易斯华盛顿大学），我们现在提议评估和跟踪这些家庭中12 -18岁的青少年。这将包括后代、侄女和侄子。这个“有风险”的群体将与一组匹配的社区比较对象进行比较。300名研究对象和300名对照者将使用已建立的青少年和父母诊断工具（KSADS-PL）进行研究。其他评估行为、性情、家庭环境和药物使用的工具也将被采用。这些数据将储存在一个数据库中，该数据库是为了便于对临床变量进行纵向研究而开发的。分析将比较高危组和对照组的潜在危险因素。高风险组的年度随访将在研究的第二年开始。假设将确定3组：1)表现为早发性双相情感障碍的有行为症状或障碍的青少年；2)有焦虑症状或障碍的青少年表现为晚发性双相情感障碍；3)有轻微情绪症状或障碍的青少年，表现为晚发性单极或双相障碍。本研究的伦理意涵将透过检视参与的影响及高风险状态对自尊的影响来研究。

DESCRIPTION (provided by applicant): Bipolar disorder is a severe heritable psychiatric illness affecting 1% of the general population. The age of onset is generally in the late teenage years or early adulthood. Very little is known about specific risk factors that influence the incidence and age of onset of this disorder. In 1988 the NIMH established a Genetics Initiative in bipolar disorder with the goal of identifying susceptibility genes; this collaboration has identified several hundred families with multiple cases of bipolar disorder. As 3 of the initial collaborating sites 'Indiana University, Johns Hopkins University, and Washington University at St Louis) we are now proposing to assess and follow adolescents, ages 12 -18 years, in these families. This will include offspring and nieces and nephews. This "at risk" group will be compared to a matched set of community comparison subjects. 300 study subjects and 300 controls will be studied using established diagnostic instruments (KSADS-PL) for the adolescents and the parents (DIGS). Other instruments to assess behavior, temperament, family environment, and substance use will be employed. The data will be stored in a database developed to facilitate longitudinal studies of clinical variables. Analyses will compare potential risk factors among the high-risk group and the controls. Annual follow-up of the high- risk group will begin in the second year of the study. It is hypothesized that 3 groups will be identified: 1) adolescents with behavioral symptoms or disorders who manifest early-onset bipolar disorder; 2) adolescents with anxiety symptoms or disorders who manifest later-onset bipolar disorder; and 3) adolescents with minor mood symptoms or disorders who manifest later-onset unipolar or bipolar disorder. The ethical implications of this research will be studied by examining the effects of participation and the effect on self-esteem due to high- risk status.