An Adaptive Algorithm-Based Approach to Treatment for Adolescent Depression

项目总结 青春期抑郁症是一种普遍存在的令人衰弱的疾病，它使年轻人处于自杀的风险中，其他 精神病诊断，青春期和成年期的功能障碍。有一种 有效治疗的数量；然而，接受这些治疗的青少年中有30%-50%没有 请回答。为了提高应答率，练习参数建议常规的系统症状 在治疗过程中进行评估，为是否更换或增加治疗提供决策依据 治疗。研究还表明，定期的症状监测可以改善治疗结果。 不幸的是，在青春期抑郁症的常规治疗中，常规的症状评估是极其罕见的。在……里面 此外，对于青少年抑郁症最常见的治疗方法--心理治疗，目前有 没有指导治疗师如何使用这些症状评估来指导后续治疗的指南 治疗决定。要解决这一关键知识差距，需要确定(1)哪些症状或患者 要评估的特征，(2)何时实施这些评估，以及(3)后续治疗 根据这些评估提供。适应性治疗策略(ATS)提供了指导算法 治疗决策。这些算法基于收集的患者特征和结果 在治疗过程中，他们提供了关于何时、如何以及为谁提供中期治疗的指导方针 应着手改变治疗方法。自动测试系统可以在 称为序贯多分配随机试验的创新实验设计的背景 (智能)。在SMART中，受试者可以被多次随机化，这些随机化发生 在选定的关键决策点按时间顺序运行。SMART的结果用于定义 构成自动测试系统的决策规则。本研究的目的是评估两种方法的有效性。 治疗青少年抑郁症的安非他明类药物。安非他明类药物包括提供循证心理治疗 青少年抑郁(人际心理治疗，IPT-A)，系统症状监测，以及 经验派生的算法，指定是否、何时以及如何增强IPT-A。200人情绪低落 青少年(12-18岁)将被招募参加为期16周的门诊SMART 社区精神卫生诊所。本R01的目的是(1)评估ATS的有效性 (2)评估青少年的人际功能，作为IPT-A的治疗目标；(3) 评估初始治疗和治疗强化策略的主持人，以及(4)进行过程 评估以确定影响ATS实施的障碍和促进者。

PROJECT SUMMARY Adolescent depression is a prevalent and debilitating disorder that places youth at risk for suicidality, other psychiatric diagnoses, and functional impairment both during adolescence and into adulthood. There are a number of effective treatments; however, 30-50% of adolescents who receive these treatments do not respond. To improve response rates, practice parameters recommend routine systematic symptom assessment over the course of treatment to inform decisions regarding whether to switch or augment treatment. Research also demonstrates that regular symptom monitoring improves treatment outcomes. Unfortunately, routine symptom assessment in usual care for adolescent depression is extremely rare. In addition, for psychotherapy, which is the most frequent treatment for adolescent depression, there are currently no guidelines to direct therapists regarding how to use those symptom assessments to guide subsequent treatment decisions. Addressing this critical knowledge gap requires identifying (1) what symptoms or patient characteristics to assess, (2) when to administer those assessments, and (3) what subsequent treatment to provide, based on those assessments. Adaptive treatment strategies (ATSs) provide algorithms for guiding treatment decision making. These algorithms are based on patient characteristics and outcomes collected during the course of therapy, and they provide guidelines regarding when, how, and for whom midcourse changes in the treatment approach should be initiated. ATSs can be developed and validated within the context of an innovative experimental design called a sequential multiple assignment randomized trial (SMART). In a SMART, subjects can be randomized multiple times and these randomizations occur sequentially through time at selected critical decision points. The results of the SMART are used to define the decision rules that make up the ATS. The purpose of the current study is to evaluate the effectiveness of two ATSs for adolescent depression. The ATSs include delivery of an evidence-based psychotherapy for adolescent depression (interpersonal psychotherapy, IPT-A), systematic symptom monitoring, and an empirically-derived algorithm that specifies whether, when, and how to augment IPT-A. 200 depressed adolescents (age 12-18) will be recruited to participate in a 16-week SMART conducted in an outpatient community mental health clinic. The aims of this R01 are to (1) evaluate the effectiveness of the ATSs embedded in this trial, (2) evaluate adolescents' interpersonal functioning as a treatment target of IPT-A, (3) evaluate moderators of initial treatment and treatment augmentation strategies, and (4) conduct a process evaluation to identify barriers and facilitators that influenced ATS implementation.