Early Phase Psychosis: Informing Treatment Decisions

描述（由申请人提供）：首次发生在青少年和年轻人中的精神疾病带来了巨大的挑战。通常诊断不明确，潜在的治疗方法也没有足够的证据。早期，适当和一致的干预是必要的，以优化结果的精神障碍的早期表现，我们将系统地解决在这种情况下的一系列问题。抗精神病药物经常用于这些不同的群体。虽然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仍有一些重大问题没有得到回答。什么是最佳的治疗，剂量和干预持续时间，以实现缓解，恢复和防止复发，在这样的人？治疗参与和治疗依从性是这些人群结局的关键驱动因素。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，特别是对那些显著导致这些人群发病率和死亡率增加的疾病和治疗相关因素的潜在影响我们中心的使命将是帮助建立和支持核心的基础设施和一系列的调查，这些调查可以为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前驱症状、精神分裂症样障碍、精神病NOS、物质诱发的精神障碍、双相障碍伴精神病特征和诊断后5年内的精神分裂症或情感性精神障碍。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病影响的个体的结果（即缓解，恢复，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产生深远的长期公共卫生后果。

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.