This competing continuation application requests funds to continue the Longitudinal Assessment of Manic Symptoms (LAMS) study at 4-sites. Over the past 3.5 years, using a valid and reliable screening instrument, children ages 6-12 years were identified with elevated symptoms of mania (ESM) at the time of their first clinical presentation. Approximately 621 youth were identified as having ESM. In addtion, 86 age/race/sex matched comparison children without ESM at first clinical presentation were enrolled. During the LAMS study, these participants were evaluated at baseline and every 6 months thereafter. At each assessment point, youths were evaluated regarding their psychiatric diagnoses, psychiatric symptomatology, mental health service utilization, and psychosocial functioning. As part of this competing continuation application (LAMS2), the investigators propose to continue these 6-month evaluations. In addition, LAMS2 will include both neurocognitive testing as well as neuroimaging techniques in order to identify possible biomarkers that reflect or are related to underlying biological mechanisms that predisopose individuals to the development of bipolar disorders. In acordance with the NIMH's Strategic Plan, LAMS2 would focus on examining and documenting trajectories of youths with ESM and related psychiatric disorders in order to better identify crucial timepoints for intervention. More specifically, the goals of LAMS2 include: 1) examining the stability of ESM over time in relation to changes in mood symptoms and DSM-IV-TR criteria for mood disorders; 2) examining the positive predictive value of ESM alone and in combination with other potential risk factors in order to better identify youth who will eventually develop bipolar disorders (BPD) as they progress into and through adolescence; 3) developing evidence-based, atheoretical, diagnostic criteria for a pediatric phenotype for bipolar spectrum disorders; 4) identifying risk factors associated with poor functional outcomes for youth with ESM; 5) examining the relationships between mood episodes and clinical outcomes over time; 6) evaluating neurocognitive performance, together with functional abnormalities in selected neural systems and their relationship to ESM and the development of BPD during youth and early adulthood. The current participants will begin the competitive renewal period ranging in age from 8-17 years. At the end of LAMS2, June 2015, the cohort will range in years from 13-22 years. For this reason, LAMS 2 will provide an opportunity for the collection of innovative and clinically important data during a period of time in which when study participants will have entered an age of high risk for the development of a bipolar spectrum disorder.
Diagnosing bipolar disorders (BPD) in youth is highly controversial. Goals of LAMS2 are to: 1) increase clarity of diagnosis (i.e., empirically delineate who does versus does not meet diagnostic criteria; develop evidence-based guidelines for diagnostic criteria in youth); 2) improve understanding of risk and protective factors that propel high-risk youth into, or away from developing BPD; 3) increase awareness of risk and protective factors that improve or detract from functional outcome for these youth; 4) learn about the structural and functional brain abnormalities that occur in youth who do, versus do not, develop BPD over time.
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