Early Phase Psychosis: Informing Treatment Decisions

描述（由申请人提供）：首次出现在青少年和年轻成人中的精神障碍带来了巨大的挑战。诊断往往不明确，潜在的治疗也没有充分的证据。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。抗精神病药物经常用于这些不同的人群。与此同时，它们的使用在短期内可能是适当的/有效的，但在它们的中期和长期使用方面仍存在未解决的重大问题。在这些个体中，达到缓解、恢复和防止复发的最佳治疗方法、剂量和干预时间是什么？治疗参与和坚持治疗是这些人群预后的关键驱动因素。在我们考虑青少年和年轻人抗精神病治疗的适当性、可接受性和效益风险比时，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（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和支持核心基础设施和一系列研究，这些研究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在诊断后的前五年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，NOS精神病，物质诱发的精神障碍，具有精神病特征的双相障碍以及诊断为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，恢复，功能，生活质量和整体健康）。我们在这一人群中进行适当、有效和持续干预的能力可能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.