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

综述：ACISR研究能力、理论依据、使命和目标的发展 在我们目前的亚洲科学研究中心及其过去四年来促进的工作中， 在优化早期阶段个体的临床结果方面实现了许多重要目标 精神分裂症然而，与此同时，我们也认识到， 有必要为经历精神病症状的年轻人做出关键的治疗决定， 症状（可能是也可能不是精神分裂症的早期表现）。我们的工作是查明， 招募并研究了数百名首发精神分裂症和五名前驱精神分裂症患者， 多年来，突出了诊断仍然不清楚的患者数量，和/或 治疗决定没有充分的证据基础。再加上我们的信念，早期，适当的， 持续的干预是必要的，以优化结果的早期阶段表现的精神病， 为了解决青少年和年轻人的精神障碍问题，我们将系统地解决这方面的一系列问题。 21岁的人表现出与物质使用有关的精神病，18岁的人表现出与物质使用有关的精神病， 具有减弱的阳性和抑郁症状的混合物，19岁的患者表现为躁狂症， 精神病症状是所有可能考虑使用抗精神病药物的个体， 经常使用。同时，它们的使用在短期内可能是适当/有效的， 关于其中期和长期使用的主要未回答问题。最佳治疗方法是什么， 剂量和持续时间的干预，以实现缓解，恢复，并防止这些人复发？ 此外，我们还需要了解这类患者目前在更大范围内的评估和治疗情况。 社区，以了解“真实的世界”的问题，面对病人和家庭，以及 在这些环境中工作的心理健康专业人员。 在这种情况下，我们还了解到，治疗参与和坚持治疗是关键 我们已经治疗的所有人群的结果驱动因素，并将继续在额外的 我们现在要研究的群体。这些问题需要在2010年更加充分和积极地加以解决。 比现在的社区。当我们考虑适当性、可接受性和受益风险比时， 在青少年和年轻人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卫生的潜在影响，特别是与疾病和治疗有关的影响 导致这些人群发病率和死亡率显著增加的因素（即， 体重增加、代谢综合征和吸烟）。这是一个简要的背景和理由的角度来看， 我们目前的建议