Early Phase Psychosis: Informing Treatment Decisions

描述(由申请人提供)：首次在青少年和年轻人中发生的精神障碍构成了巨大的挑战。通常情况下，诊断并不清楚，潜在的治疗方法也没有足够的证据。早期、适当和持续的干预是必要的，以优化精神障碍早期表现的结果，我们将在这方面系统地解决一系列问题。抗精神病药物在这些不同的人群中经常使用。虽然它们的使用在短期内可能是适当的/有效的，但关于它们的中期和长期使用仍有一些重大的悬而未决的问题。为了缓解、康复和防止这些人复发，最佳的治疗方法、剂量和干预持续时间是什么？治疗的参与度和对治疗的坚持是这些人群结果的关键驱动因素。当我们考虑青少年和青壮年抗精神病药物治疗的适当性、可接受性和受益/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大幅增加的疾病和治疗相关因素(如体重增加、代谢综合征和吸烟)。我们中心的使命将是帮助建立和支持核心使能基础设施和一系列研究，这些研究可以为有关早期精神病的关键诊断和个体化治疗决策提供信息。我们将早期阶段定义为确诊后的头五年内或处于主要的高风险类别。在高危和早期精神障碍的范畴下，我们包括精神分裂症和双相先兆、分裂样障碍、精神病NOS、物质诱导性精神病、具有精神病特征的双相障碍和诊断五年内的精神分裂症或分裂情感性障碍。最终，我们希望改善在发展和个性化的关键阶段受任何精神疾病影响的个人的结果(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、有效和一致的干预的能力可能会对公共卫生产生深远的长期影响。

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.