The Phenomenology And Neurophysiology Of Juvenile Bipolar Disorder

这项研究的目的是确定调节儿童和青少年双相情感障碍(BD)症状的大脑机制。为了做到这一点，患者和对照组完成了标准化的行为范式，旨在评估对情绪刺激的反应，如奖励和惩罚，或表现出情绪的面孔。大约有100名患者和相匹配的对照组在一系列这样的范例上进行了评估。综上所述，这些数据表明，患有BPD的儿童难以调整他们的行为，以应对环境中情绪刺激的变化。这些缺陷在反应逆转任务中很明显，有两项任务测试他们抑制主导运动反应并启动另一项反应的能力，另一项任务是评估他们在受挫背景下的行为。此外，我们的数据表明，患有BPD的儿童难以准确识别面部情绪。使用功能磁共振成像，我们已经识别出与面部标记缺陷相关的杏仁核过度活动，以及与运动抑制和反应灵活性缺陷相关的前额叶和纹状体异常。基于这些发现，我们正在启动基因研究，旨在确定与双相情感障碍相关的基因多态与功能磁共振确定的大脑激活异常模式之间的关联。此外，我们已经开始对有BPD风险的儿童进行研究，因为他们的父母或兄弟姐妹患有BPD。这项研究的目的是确定我们确定的行为缺陷是否是家族性的，因此可能是BPD的候选内表型。到目前为止，我们的数据表明，BD高危青少年在面部情绪识别方面表现出与BD青少年相似的缺陷，表明这种缺陷可能与疾病的原因有关，而不仅仅是儿童生病的结果。此外，今年我们招募了ADHD儿童作为BPD儿童的精神科对照组，目前正在分析功能磁共振数据，以确定在执行面部情绪识别和反应灵活性任务时，这些组的大脑功能可能会有什么不同。最后，我们继续评估家庭成员的精神状态，保存患者和父母的基因样本，以便在未来的研究中使用，并纵向跟踪患者(临床和结构性核磁共振扫描)。

This purpose of this study to identify brain mechanisms mediating the symptoms of bipolar disorder (BD)in children and adolescents. To do this, patients and controls complete standardized behavioral paradigms designed to assess responses to emotional stimuli, such as reward and punishment, or faces displaying emotion. Approximately 100 patients and matched controls have been assessed on a battery of such paradigms. Taken together, these data indicate that children with BPD have difficulty adapting their behavior in response to changes in emotional stimuli in their environment. These deficits are evident on response reversal tasks, two tasks testing their ability to inhibit a dominant motor response and initiate another, and a task that assesses their behavior in the context of frustration. In addition, our data indicate that children with BPD have difficulty identifying facial emotion accurately. Using functional MRI, we have identified amygdala hyperactivity that is associated with the face labeling deficit, and prefrontal and striatal abnormalities associated with deficits in motor inhibition and response flexibility. Based on these findings, we are initiating genetic studies aimed at identifying associations between polymorphisms associated with bipolar disorder and abnormal patterns of brain activation identified with functional MRI. In addition, we have begun a study of children who are at risk for BPD because they have a parent or sibling with the illness. The goal of this study is to ascertain whether the behavioral deficits that we identified are familial and therefore may be candidate endophenotypes for BPD. Thus far, our data indicate that youth at risk for BD show deficits in face emotion identification similar to those seen in youth with BD, indicating that such deficits may be related to causes of the illness, rather than simply being a result of the child being ill. In addition, this year we recruited children with ADHD as a psychiatric comparison group for children with BPD, and are currently analyzing functional MRI data to ascertin how brain function may differ among these groups while performing face emotion identification and response flexibility tasks. Finally, we continue to assess the psychiatric status of family members, bank genetic samples from patients and parents for use in future studies, and follow the patients longitudinally (clinically and with structural MRI scans).