Bipolar disorder (BPD) affects a minimum of 2.3 million American adults aged 18 and older (1.2% of US population) and in the 5-9% of children with serious emotional disturbances, the prevalence of BPD is unknown, in 1990, BPD in established market economies resulted in 1.7 million years of lost healthy life due to premature death or disability, third only to major depression and schizophrenia. About 15% of patients with BPD commit suicide. The proportion of the NIMH dollar that goes to support research in BPD is less than expected by NIMH leadership, and there are no NIMH-funded BPD research centers. These data suggest there exists an urgent need for an NIMH research center dedicated to BPD research across the life cycle. The proposed Center addresses many of the recommendations in the 1999 """"""""Bridging Science and Services"""""""" report by focusing on the utilization of novel longitudinal study designs in complex comorbid groups of patients with BPD from ages 5 through the end of life, as well as by focusing on function and disability, not just symptom improvement. The scientific theme of this Center will be conduct of studies designed to """"""""improve clinical outcomes in underserved population of BPD, including those receiving care within community mental health centers (CMHC), children and adolescents, and adults currently abusing alcohol and/or drugs. The pilot projects include: 1) a single-center psychosocial intervention study designed to develop an efficient and practical way of improving treatment adherence in 166 adults with BPD in a CMHC, 2) a single-center child services project intended to improve the early and accurate recognition of BPD in 615 children and adolescents evaluated at a CMHC, and 3) a six-month, two-center, double-blind, parallel-group comparison of two regimens of combination therapy (lithium/divalproex/lamotrigine versus lithium/divalproex/placebo) for the acute and continuation outpatient management of 90 adult patients with rapid cycling BPD comorbid with alcohol, cannabis, and/or cocaine abuse/dependence at Case Western Reserve University/University Hospitals of Cleveland and a CMHC. This application will be used to build and maintain a network of sites to conduct clinical trials research that concurrently addresses issues of efficacy and effectiveness in BPD across the life cycle. This Developing Center application will be used to develop research partnerships with community settings and grow ongoing relationships, and is intended to lead to an Advanced Center submission in five years.
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