Early Phase Psychosis: Informing Treatment Decisions

早期精神病：告知治疗决策

• 批准号: 8301782
• 负责人: JOHN M KANE
• 金额: $ 154.65万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-27 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8301782
• 关键词: Address; Adherence; Adolescent; Adverse effects; Affect; Antipsychotic Agents; Bipolar Disorder; Categories; Clinical Trials; Collaborations; Community Hospitals; Development; Diagnosis; Diagnostic; Differential Diagnosis; Disease remission; Dose; Drops; Early treatment; Ensure; Environment; Evidence based treatment; Family; Fertilization; Fostering; Goals; Government; Health Status; Impaired cognition; Individual; Individuation; Intervention; Intervention Studies; Investigation; Knowledge; Medical; Metabolic syndrome; Methods; Mission; Morbidity - disease rate; National Institute of Mental Health; Nature; Odds Ratio; Onset of illness; Outcome; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Phase; Play; Population; Psychopathology; Psychotic Disorders; Public Health; Quality of life; Recovery; Recovery of Function; Recruitment Activity; Relapse; Research; Research Infrastructure; Research Personnel; Research Subjects; Research Training; Resources; Risk; Role; Schizoaffective Disorders; Schizophrenia; Schizophreniform Disorder; Series; Severities; Smoking; Staging; Symptoms; Therapeutic; Time; Training; Treatment Effectiveness; Treatment Refusal; Weight Gain; clinically significant; design; evidence base; experience; global health; high risk; improved; interest; mortality; prevent; programs; psychosocial; success; technological innovation; young adult

DESCRIPTION (provided by applicant): Psychotic disorders occurring for the first time in adolescents and young adults pose enormous challenges. Often diagnosis is unclear and potential treatments are not sufficiently evidence-based. Early, appropriate and consistent intervention is necessary in order to optimize outcomes in an early manifestation of a psychotic disorder and we will systematically address a range of issues in this context. Antipsychotic medications are frequently used in these diverse groups. At the same time that their use might be appropriate/efficacious in the short term, there are major unanswered questions regarding their intermediate and long-term use. What are the optimal treatments, dosing and duration of intervention to achieve remission, recovery and to prevent relapse in such individuals? Therapeutic engagement and adherence with treatment are key drivers of outcomes in these populations. As we consider the appropriateness, acceptability and benefit-to-risk ratio of antipsychotic treatments in adolescents and young adults, we also have to consider and address the potential effects of our interventions on global health and, in particular, on those illness and treatment-related factors which contribute so dramatically to increased medical morbidity and mortality in these populations (i.e. weight gain, metabolic syndrome and smoking).The mission of our Center will be to help to establish and support core enabling infrastructure and a series of investigations which can inform critical diagnostic and individual treatment decisions regarding early phase psychotic disorders. We define early phase as being within the first five years following a diagnosis or being in a major high risk category. Under the rubric of high risk and early phase psychotic disorders we include the schizophrenia and bipolar prodrome, schizophreniform disorder, psychosis NOS, substance-induced psychotic disorder, bipolar disorder with psychotic features and schizophrenia or schizoaffective disorder within five years of diagnosis. Ultimately, we hope to improve the outcome (i.e. remission, recovery, functioning, quality of life and global health) of individuals affected by any psychotic illness during a critical stage of development and individuation. Our ability to intervene appropriately, effectively and consistently in this population can have profound long-term public health consequences.

描述（由申请人提供）：首次在青少年和年轻人中出现的精神障碍带来了巨大的挑战。通常诊断不明确，潜在的治疗方法也没有充分的证据基础。为了优化精神障碍早期表现的结果，早期、适当和持续的干预是必要的，我们将系统地解决这方面的一系列问题。这些不同的群体经常使用抗精神病药物。与此同时，它们的使用在短期内可能是适当/有效的，但关于它们的中期和长期使用，还存在一些尚未解答的重大问题。对于这些个体来说，实现缓解、恢复和防止复发的最佳治疗方法、剂量和干预持续时间是什么？治疗参与和坚持治疗是这些人群结果的关键驱动因素。当我们考虑青少年和年轻人抗精神病药物治疗的适当性、可接受性和获益风险比时，我们还必须考虑和解决我们的干预措施对全球健康的潜在影响，特别是对那些导致这些人群的医疗发病率和死亡率显着增加的疾病和治疗相关因素（即体重增加、代谢综合征和吸烟）的潜在影响。我们中心的使命是帮助建立 支持核心基础设施和一系列调查，这些调查可以为有关早期精神障碍的关键诊断和个体治疗决策提供信息。我们将早期阶段定义为诊断后的前五年内或处于主要高风险类别。在高风险和早期精神障碍的标题下，我们包括精神分裂症和双相情感障碍、精神分裂样障碍、NOS精神病、物质诱发的精神障碍、具有精神病特征的双相情感障碍以及诊断后五年内的精神分裂症或分裂情感性障碍。最终，我们希望在发展和个性化的关键阶段改善受任何精神疾病影响的个体的结果（即缓解、康复、功能、生活质量和全球健康）。我们对这一人群进行适当、有效和持续干预的能力可能会对公共卫生产生深远的长期影响。