Preschool Mood Disorders: Continuity and School Age Outcomes

描述(由申请人提供)：基于发育性和探索性临床研究的结果，申请人的K08研究为一种特定和稳定的学龄前抑郁综合征提供了经验验证。应激皮质醇反应性的改变，以及消极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旨在通过在以社区为基础的大规模研究人群中调查学龄前抑郁症的亚型和发展特征来推进这些发现，这些研究人群因情绪障碍而被过度抽样。一种NIMH补充剂使躁狂症状的探索性调查成为可能。在这个独立的样本中，重复和扩展了证实学龄前抑郁症的发现。此外，还出现了有效而有力的学龄前双相情感障碍的初步证据。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，为纵向跟踪提供了丰富的资源。这项申请建议通过检查N=302名学龄前儿童的病程和特征来继续这项关于学龄前情绪障碍的调查，以便在整个学龄期间每年进行3次额外的诊断和发展评估。拟议的纵向研究将允许首次调查情绪障碍，从已知的最早出现在学龄前阶段，到学龄后期的结果，与扰乱和健康的儿童进行比较。本研究旨在探讨情绪发育中的发病年龄、亚型和偏差对早发性心境障碍病程和结局的影响。虽然关于儿童后期情绪障碍的纵向过程已知很多，但在从学龄前到学龄期结果的连续性和中介方面的数据库中还存在一个空白。这种发育转变对公共健康至关重要，因为在发育和神经生物变化较大的时期，有可能对这些慢性疾病进行更早和更有效的干预。这一研究样本包含了高比例的有情绪障碍的学龄前儿童和适当的控制措施，为弥合经验数据库中的这一差距提供了前所未有的机会。这些发现将为未来情绪障碍的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.