Neuroprogression across the Early Course of Psychosis.
Neuroprogression across the Early Course of Psychosis.
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DOI：
10.20900/jpbs.20200002
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发表时间：
2020-01-01
期刊：
影响因子：
--
通讯作者：
Shenton, Martha E
中科院分区：
文献类型：
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作者：
Lewandowski, Kathryn E;Bouix, Sylvain;Shenton, Martha E
精神障碍是严重的，使人虚弱，甚至是致命的。制定有针对性和有效的精神病干预措施取决于对疾病进展的时间和性质的清楚了解，以达到适合干预的目标过程。强有力的证据表明，早期和正在进行的神经渐进性变化，但时间和拐点仍不清楚，可能在认知、临床和大脑指标上有所不同。此外，在第一次发病和已确诊疾病之间的“过渡期”，各种模式的细粒度证据尤其稀少--这几年可能对改善结果特别关键，在此期间干预可能最有效。我们的目标是在精神病患者的交叉诊断样本中系统地、多模式地描述早期病程中的神经进展。我们的目标是(1)在疾病的前八年的多项评估中询问神经认知、大脑结构测量和网络连通性，以绘制神经进步轨迹图，以及(2)检查轨迹作为临床和功能结果的预测因子。我们将招募192名精神病患者和36名健康对照。评估将在基线时进行，并使用临床、认知和成像测量进行8个月和16个月的随访。我们将采用加速纵向设计(ALD)，与单一队列纵向研究相比，它允许在更长的时间范围内以更频繁的间隔确定数据。这项研究的结果有望加速确定与临床结果密切相关的可行治疗目标，并确定具有共同神经进步轨迹的亚组，以发展个性化治疗。
Psychotic disorders are severe, debilitating, and even fatal. The development of targeted and effective interventions for psychosis depends upon on clear understanding of the timing and nature of disease progression to target processes amenable to intervention. Strong evidence suggests early and ongoing neuroprogressive changes, but timing and inflection points remain unclear and likely differ across cognitive, clinical, and brain measures. Additionally, granular evidence across modalities is particularly sparse in the "bridging years" between first episode and established illness-years that may be especially critical for improving outcomes and during which interventions may be maximally effective. Our objective is the systematic, multimodal characterization of neuroprogression through the early course of illness in a cross-diagnostic sample of patients with psychosis. We aim to (1) interrogate neurocognition, structural brain measures, and network connectivity at multiple assessments over the first eight years of illness to map neuroprogressive trajectories, and (2) examine trajectories as predictors of clinical and functional outcomes. We will recruit 192 patients with psychosis and 36 healthy controls. Assessments will occur at baseline and 8- and 16-month follow ups using clinical, cognitive, and imaging measures. We will employ an accelerated longitudinal design (ALD), which permits ascertainment of data across a longer timeframe and at more frequent intervals than would be possible in a single cohort longitudinal study. Results from this study are expected to hasten identification of actionable treatment targets that are closely associated with clinical outcomes, and identify subgroups who share common neuroprogressive trajectories toward the development of individualized treatments.