Knowledge Transfer Unit(OPERATIONS CORE)

知识转移单元（运营核心）

• 批准号: 7921178
• 负责人: JOHN M KANE
• 金额: $ 5.99万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-27 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7921178
• 关键词: 18 year old; 19 year old; 21 year old; Acute; Address; Adherence; Adolescent; Adult; Adverse effects; Affect; Alcohol or Other Drugs use; Algorithms; Antidepressive Agents; Antipsychotic Agents; Anxiety; Attenuated; Belief; Biological Markers; Childhood Schizophrenia; Clinical; Clinical Trials; Clozapine; Communities; Coupled; Data; Development; Diagnosis; Diagnostic; Differential Diagnosis; Disease remission; Dose; Ethnic group; Family; Goals; Guidelines; Health; Health Professional; Health behavior; Hospitals; Incipient Schizophrenia; Individual; Individuation; Intervention; Investigation; Knowledge; Leadership; Learning; Link; Maintenance; Manic; Medical; Mental Depression; Mental Health; Metabolic; Metabolic syndrome; Mission; Morbidity - disease rate; Odds Ratio; Outcome; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Play; Polypharmacy; Population; Positioning Attribute; Prevention; Procedures; Protocols documentation; Psychotic Disorders; Public Health; Quality of life; Recovery; Recovery of Function; Recruitment Activity; Relapse; Research; Research Personnel; Research Subjects; Residual state; Resources; Risk; Role; Schizophrenia; Series; Signs and Symptoms; Smoking; Staging; Subgroup; Symptoms; Therapeutic; Time; Training; Vulnerable Populations; Weight Gain; Work; base; community based practice; comparative effectiveness; depressive symptoms; evidence base; experience; first episode schizophrenia; global health; improved; mortality; patient population; prevent; psychotic mania; racial and ethnic; response; tool; treatment response; young adult

OVERVIEW: DEVELOPMENT OF ACISR RESEARCH CAPACITY, RATIONALE, MISSION AND GOALS During the course of our current ACISR and the work that it has facilitated over the past four years we achieved a number of important goals in optimizing clinical outcomes for individuals with eariy phase schizophrenia. At the same time, however, we have recognized that there are important gaps in the evidence necessary to make critical treatment decisions for young individuals experiencing psychotic signs and symptoms (which may or may not be an eariy manifestation of schizophrenia). Our work in ascertaining, recruiting and studying hundreds of first-episode schizophrenia and putafive prodromal schizophrenia patients over the years has highlighted the number of patients in whom the diagnosis remains unclear, and/or for whom treatment decisions are not sufficiently evidence based. Coupled with our belief that eariy, appropriate and consistent intervention is necessary to optimize outcomes in an early phase manifestation of a psychotic disorder in adolescents and young adults, we will systematically address a range of issues in this context. The 21 year old who presents with a psychosis associated with substance use, the 18 year old who presents with a mixture of attenuated positive and depressive symptoms, the 19 year old who presents with mania and psychotic symptoms are all individuals for whom antipsychotic medications might be considered, and are frequently used. 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? In addition, we also need to know how such patients are currently being evaluated and treated in the larger community in order to understand the "real worid" issues that confront patients and families as well as the mental health professionals working in those settings. In this context, we have also learned that therapeutic engagement and adherence with treatment are key drivers of outcomes in all of the populations that we have treated, and, will continue to be in the additional groups we will now study. These issues need to be addressed far more adequately and proactively in the community than they are currently. 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 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). This is a brief perspective on the background and rationale for our current proposal

概述：ACISR研究能力，理由，任务和目标的发展 在当前的ACISR和过去四年中它促进的工作过程中 在优化具有耳相的个体的临床结果方面实现了许多重要目标 精神分裂症。但是，与此同时，我们已经认识到证据存在重要差距 对于经历精神病迹象的年轻人做出关键的治疗决定和 症状（可能是精神分裂症的耳朵表现）。我们确定的工作， 招募和研究数百个第一集精神分裂症和putafive前驱精神分裂症患者 多年来，诊断尚不清楚的患者数量和/或 治疗决策不是足够的证据。再加上我们的信念，即适当，适当和 在精神病的早期表现中优化结果是必要的一致干预措施 在这种情况下，我们将系统地解决一系列问题。 这位21岁的人提出了与药物使用相关的精神病，18岁的孩子 伴有衰减阳性和抑郁症状的混合物，以躁狂和 精神病症状都是可能考虑抗精神病药的人，并且是 经常使用。同时，它们在短期内可能是适当/有效的 有关其中间和长期使用的主要未解决问题。什么是最佳治疗方法， 剂量和干预持续时间以实现缓解，恢复和防止此类人的复发？ 此外，我们还需要知道当前如何在较大的情况下评估和治疗此类患者 社区以了解患者和家庭以及 精神卫生专业人员在这些环境中工作。 在这种情况下，我们还了解到治疗和遵守治疗是关键 我们所治疗的所有人群中结果的驱动因素，并将继续在其他 我们现在将学习的小组。这些问题需要在 社区比目前。当我们考虑适当性，可接受性和利益风险比率时 在青少年和年轻人中的抗精神病药物治疗中，我们还必须考虑和解决 我们的干预措施对全球健康，尤其是与疾病和治疗有关的影响 对这些人群的医疗发病率和死亡率的提高（即 体重增加，代谢综合征和吸烟）。这是关于背景和理由的简短观点 我们目前的建议