Early Phase Psychosis: Informing Treatment Decisions

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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.