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PREMAP - Predictors and Risk Evaluation for Menopause-Associated Psychosis

PREMAP - 更年期相关精神病的预测因素和风险评估

基本信息

批准号：
10567665
负责人：
Albert R Powers
金额：
$ 82.27万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-18 至 2027-10-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10567665
关键词：
Admission activity Adolescence Age Aging Applications Grants Attenuated Behavioral Belief Biological Markers Clinical Data Development Diagnosis Disease Early identification Early treatment Electrophysiology (science)Elements Endocrinology Epidemiology Estradiol Estrogen decline Estrogens Evaluation Exhibits Family Funding Opportunities Future Gender Goals Hormonal Hormones Image Incidence Individual Intervention Interview Life Longevity Medical Medical History Menopause Menstrual cycle Mental Depression Mental disorders Moods National Institute of Mental Health Neurobehavioral Manifestations Neurobiology Outcome Participant Performance Perimenopause Persons Phase Placebos Population Postpartum Depression Postpartum Period Predisposing Factor Pregnancy Premature Menopause Progesterone Prospective Studies Psychoses Psychotic Disorders Randomized, Controlled Trials Recording of previous events Relative Risks Reporting Retrospective Studies Risk Risk Factors Risk Marker Schizophrenia Semantics Severities Source Structure Symptoms System Testing Time Study Unipolar Depression Update Vulnerable Populations Woman Work Youth attenuated psychosis syndrome behavior prediction clinical high risk for psychosis cohort comorbidity dysphoria early psychosis emerging adult experience first episode psychosis functional decline high risk improved men neural neuroprotection prospective psychosis risk psychotic symptoms recruit reproductive reproductive hormone response risk mitigation risk prediction risk stratification schizophrenia risk sex symptomatic improvement theories treatment strategy young adult

项目摘要

Schizophrenia and other psychotic disorders are typically thought of as disorders of adolescence and early adulthood: the peak incidence of new psychotic disorder diagnoses is from 15 to 19 in men and 20 to 24 in women. However, women also demonstrate a second peak of incidence and vulnerability to the illness in their 40s and early 50s. Theories have been proposed to explain this second peak, including appeals to the neuroprotective effects of estrogen and other reproductive hormones, which wane in the years preceding menopause. Despite these observations and theoretical groundwork, very little evidence exists to identify risk factors for development of psychosis in women experiencing the menopause transition. This is partly because development of psychosis in this population is relatively rare and is thus difficult to observe. In response to the NIMH funding opportunity announcement entitled, “Mood and Psychosis Symptoms during the Menopause Transition”, we propose a two-pronged approach to identify risk factors for development of psychosis during the menopause transition. In our first aim, we propose to recruit from established local and national sources 179 individuals who have developed a first episode of psychosis during the menopause transition and to retrospectively identify elements of medical, reproductive, psychiatric, and family history that predispose to the development of psychosis when compared to 144 matched controls who developed depression in the same period. We hypothesize that women who developed psychosis during the menopause transition will report a prodromal period of attenuated symptoms preceding the development of frank psychosis, that factors generally predisposing to psychosis onset will be relatively over-represented in the psychosis cohort, and that psychiatric disorders tied to hormone fluctuations will be elevated in both cohorts relative to population rates. In our second aim, we propose to leverage our team’s established expertise in identifying risk factors for psychosis to prospectively study women who have attenuated psychotic symptoms, elevating their risk for developing psychosis. From established sources, we will identify 196 women who are at clinical high risk for psychosis during the earliest phases of the menopause transition. We will then follow these women and 98 matched healthy controls over 2 years, collecting clinical, behavioral, computational, endocrinological, and (in an exploratory subset) imaging and electrophysiological data as they transition toward menopause. We hypothesize that baseline psychotic and cognitive symptom severity will predict conversion to psychosis and that the worsening of these symptoms will correspond to specific clinical and hormonal markers of the menopause transition. We also hypothesize that candidate psychosis biomarkers will predict conversion and functional decline and will be impacted by markers of the menopause transition. Together, these studies will be the first to identify definitive risk factors for psychosis development in aging women. Our goal is to use the data generated to develop specific interventions to mitigate risk for psychosis in this vulnerable population.

精神分裂症和其他精神障碍通常被认为是青春期和早期的障碍