Psychosis in Schizophrenia: Mechanisms of Recovery

描述（由申请人提供）：David Kimhy博士将在精神分裂症患者压力调节和精神病的认知和神经生物学机制方面进行培训和研究。训练和研究计划的目标是围绕认知应对策略介导精神分裂症精神病康复期间压力和精神病症状之间的联系这一假设进行整合的。在Dolores Malaspina博士的赞助下，该培训计划利用了NYSPI/哥伦比亚大学的资源，将正式课程，直接监督，临床研究经验和培训相结合。该计划包括在关键领域的指导和教学指导，包括：1)使用经验抽样方法（ESM）进行精神分裂症的精神病研究，2)评估压力调节系统的临床方法，3)使用多层次线性模型进行数据分析，以及4)精神病的认知行为治疗（CBTp）。目前的方法在建立压力瞬间变化和精神病之间的因果关系方面具有有限的生态学有效性。Kimhy博士将利用心脏自主调节的动态评估（心率变异性；HRV）与Palm掌上电脑使用经验采样法（ESM）收集的数据同步，同时研究精神病的实时生理和心理相关性。研究计划包括同时探查瞬时精神病症状、主观压力、HRV和认知应对策略。评估将在精神病药物和CBTp治疗前后进行。这种方法将基础科学转化为实时、真实环境（体内和原位）的应用，允许将精神病作为日常功能起落的一部分进行评估。了解这些相互作用将促进我们对精神分裂症患者精神病康复机制的理解。拟议的培训和研究计划将为Kimhy博士提供必要的知识、培训和经验，使其成为一名专注于精神分裂症中压力调节和精神病的神经生物学和心理机制的独立研究人员。

DESCRIPTION (provided by applicant): In this revised application for a Mentored Patient-Oriented Research Career Development Award (K23), Dr. David Kimhy will pursue training and research in the cognitive and neurobiological mechanisms of stress regulation and psychosis in schizophrenia. The goals of the training and research plan are integrated around the hypothesis that cognitive coping strategies mediate the link between stress and psychotic symptoms during recovery from psychosis in schizophrenia. Under the sponsorship of Dr. Dolores Malaspina, the training plan capitalizes on the resources of NYSPI/Columbia University, combining formal coursework, direct supervision, and clinical research experience and training. The plan involves mentorship and didactic instruction in key areas including: 1) psychosis research in schizophrenia using of Experience Sampling Method (ESM), 2) clinical methodologies for assessment of stress-regulating systems, 3) data analysis using multilevel linear modeling, and 4) cognitive-behavior therapy for psychosis (CBTp). Current methodologies have limited ecological validity to establish causal links between momentary changes in stress and psychosis. Dr. Kimhy will study simultaneously the real-time physiological and psychological correlates of psychosis using ambulatory assessment of cardiac autonomic regulation (Heart Rate Variability; HRV) synchronized with data collected using Experience Sampling Method (ESM) with Palm handheld computers. The research plan involves simultaneous probing of momentary psychotic symptoms, subjective stress, HRV, and cognitive coping strategies. Assessments will be conducted before and after pharmacological and CBTp treatments of psychosis. This methodology translates basic science into use in real-time, real-world environments (in-vivo and in-situ), allowing for the assessment of psychosis as part of the ebb-and-flow of daily functioning. Understanding these interactions will advance our understanding of the mechanisms of recovery from psychosis in schizophrenia. The proposed training and research plan will provide Dr. Kimhy with the knowledge, training, and experience necessary to develop as an independent researcher focusing on the neurobiological and psychological mechanisms of stress regulation and psychosis in schizophrenia.