Development of a transdiagnostic intervention for adolescents at risk for serious mental illness

总结 亚临床精神病性症状是一种多能转诊断危险因素， 随后发生严重精神疾病（精神病性或非精神病性）和当前精神疾病的风险增加 痛苦然而，试图预防这些慢性疾病的发病在个人与亚临床 精神病症状的治疗效果有限这可能是由于大多数先前的研究集中在一个 相对晚期的风险，当疾病过程可能正在进行中，因此更难 反面.在生命的早期，即青春期进行干预-这一时期的特点是高水平的 神经可塑性-可能是特别重要的预防性干预措施，同时也解决了高度 目前迫切需要为青年提供更多的心理健康服务。 在过去的几年里，我们已经开发并测试了一种针对年轻人的简短的，基于小组的干预措施。 这就是所谓的恢复力训练（RT）。RT侧重于提高支持社会功能的能力， 包括社会认知，涉及准确感知他人的神经心理学过程， 精神状态当这些能力得到加强时，这种改善可能会导致降低失业率。 精神病理学在两个已发表的试验中，我们报告说RT导致一系列症状的减少 改善社会功能。此外，社会认知的改善，特别是心理理论， 理解他人精神状态的能力，与RT相关的精神疾病减少有关。 症状和改善社会功能在这个危险的年轻成年人群体。 基于这些先前的发现，该项目的目标是使RT适应高危青少年 他们将通过在高中进行的简短心理健康筛查被招募， 那些有亚临床精神病症状，但尚未接受任何精神健康治疗的人。我们将 首先测试适应性干预措施在该人群中的可行性和可接受性，然后进行试点 随机，等待名单对照试验，以测试其在减少转诊断症状和改善 社会功能我们还将衡量所提出的干预目标机制、社会 认知，在任何干预相关的改善中发挥作用。如果这个项目的假设得到证实， 随后将进行一项明确的、纵向的、随机对照试验，以衡量这种治疗的疗效。 新的干预措施，以防止残疾的transdiagnosically高危青少年。 在这个项目的过程中，在经验丰富的多学科专家的指导下， 导师团队，课程，以及一个全面的培训计划，涉及社会研究的培训 认知，青少年心理健康，纵向生物统计学和干预适应，申请人将 发展必要的知识和技能，成为一个独立的干预研究，重点是 制定预防和治疗青少年严重精神疾病的方法。

Summary Subclinical psychotic symptoms are a pluripotent transdiagnostic risk factor, associated both with an increased risk of subsequently developing a serious mental illness (psychotic or non) and current psychiatric distress. However, attempts to prevent the onset of these chronic illnesses in individuals with subclinical psychotic symptoms have had limited success. This may be due to the majority of prior studies focusing on a relatively late stage of risk, when the illness processes are possibly well underway and thus more difficult to reverse. Intervening earlier in the lifespan, during adolescence - a time characterized by high levels of neuroplasticity - could be particularly important for preventive interventions, while also addressing the highly pressing current need for more mental health services for youth. During the past few years, we have developed and tested a brief, group-based intervention for young adults, called Resilience Training (RT). RT focuses on increasing capacities that support social functioning, including social cognition, the neuropsychological processes involved in accurately perceiving others and their mental states. When these capacities are enhanced, such improvements may lead to lower rates of psychopathology. In two published trials, we have reported that RT led to reductions in a range of symptoms and improved social functioning. Additionally, improvements in social cognition, particularly in Theory of Mind, the ability to understand the mental states of others, are linked to RT-related decreases in psychiatric symptoms and improvements in social functioning in this at-risk young adult group. Based on these prior findings, the goal of the proposed project is to adapt RT for at-risk adolescents who will be recruited using a brief mental health screening administered in their high schools, which will identify those who have subclinical psychotic symptoms but are not yet receiving any mental health treatment. We will first test the adapted intervention for its feasibility and acceptability in this population, and then conduct a pilot randomized, waitlist-controlled trial, to test for its efficacy in reducing transdiagnostic symptoms and improving social functioning. We will also measure whether the proposed target mechanism of the intervention, social cognition, plays a role in any intervention-related improvements. If the hypotheses of this project are confirmed, it will be followed by a definitive, longitudinal, randomized control trial, which will measure the efficacy of this novel intervention for preventing disability in transdiagnostically at-risk adolescents. During the course of this project, with the guidance of a highly experienced multi-disciplinary mentorship team, coursework, and a comprehensive training plan that involves training in research on social cognition, adolescent mental health, longitudinal biostatistics, and intervention adaptation, the applicant will develop the necessary knowledge and skills to become an independent intervention researcher, focused on developing approaches for the prevention and treatment of serious mental illnesses in young people.