Prediction of Psychosis in Schizotypal Adolescents

描述(由申请人提供)：对预防的可能性感兴趣 近年来，精神病的发病人数有所增加。身份的鉴定 处于危险中的个人将是早期发展的关键的第一步 预防试验。众所周知，精神病的临床发病 通常在此之前有显著的行为障碍，这成为最 在青春期明显。事实上，绝大多数患者都表现出 青春期的适应问题；通常是一种“前驱”行为综合征 类似于SPD。到目前为止，对有前驱症状的年轻人进行的前瞻性研究有 显示出1到3个内的高Axis I结果比率(30%到40%) 多年来，贷款支持了行为风险指标的效用。按顺序 为了提高预测效度，使之超越行为标准所达到的效果， 可能需要包括生物风险因素在内的多因素方法。 我们的初步研究结果表明，患有这种疾病的青少年 分裂型人格障碍(SPD)表现出几种生理指标 在精神分裂症患者中观察到的，包括变形障碍 特征，运动异常，皮质醇升高。此外，社民党 青少年有更明显的变形特征，运动异常 皮质醇升高更有可能表现出症状恶化或轴心I 在两到三年内出现混乱。拟议的研究代表了一项 本研究的复制和推广。主要目标是阐明 假定的行为和生物风险指标的预测效度 和2)阐明神经成熟的过程 这可能与前驱症状的出现有关。特别的 人们感兴趣的是下丘脑-垂体-肾上腺(HPA)的特殊作用 轴作为调节神经系统影响潜伏期的表达 漏洞。这项研究将探索直接和互动的影响 畸形特征(轻微的身体和皮肤异常)，运动 发育过程中的异常和皮质醇分泌 患有SPD和其他轴II障碍的青少年。参与者将被跟踪 在四年的时间里记录行为发展、精神症状 和HPA活性。由此产生的数据将使我们能够解决关键问题 关于高危青少年精神障碍的发展和预测。 从长远来看，这项研究有望产生如下发现： 我们对精神分裂症前驱病程概念化的启示 和其他精神病患者，以及预防性干预的方法。

DESCRIPTION (provided by applicant): Interest in the possibility of preventing the onset of psychosis has grown in recent years. The identification of individuals at risk will be a critical first step in the development of early prevention trials. It is well established that the clinical onset of psychosis is usually preceded by significant behavioral dysfunction, which becomes most pronounced during adolescence. In fact, the vast majority of patients manifest adjustment problems during adolescence; often a 'prodromal' behavioral syndrome similar to SPD. To date, prospective studies of youth with prodromal signs have shown a high rate of Axis I outcomes (30 to 40 percent) within one to three years, lending support to the utility of behavioral risk indicators. In order to improve predictive validity beyond that achieved with behavioral criteria, a multifactorial approach that includes biological risk factors may be needed. Findings from our preliminary research indicate that adolescents with schizotypal personality disorder (SPD) manifest several physical indicators that have been observed in schizophrenia patients, including dysmorphic features, movement abnormalities, and elevated cortisol. Further, SPD adolescents with more pronounced dysmorphic features, movement abnormalities and cortisol elevations are more likely to show symptom exacerbation or Axis I disorder within two to three years. The proposed research represents a replication and extension of this study. The chief goals are to elucidate the predictive validity of putative behavioral and biological indicators of risk for psychotic disorders, and 2) to shed light on neuromaturational processes that might be involved in the emergence of prodromal features. Of particular interest is the particular role of the hypothalamic-pituitary-adrenal (HPA) axis as a moderating neural system that influences the expression of latent vulnerabilities. The study will explore the direct and interactive effects of dysmorphic features (minor physical and dermal abnormalities), movement abnormalities, and cortisol secretion on the developmental course of adolescents with SPD and other Axis II disorders. Participants will be followed for a four-year period to chart behavioral development, psychiatric symptoms and HPA activity. The resultant data will allow us to address key questions about the development and prediction of psychotic disorders in at-risk youth. In the long-term, the research holds promise for yielding findings that have implications for our conceptualization of the prodromal course of schizophrenia and other psychoses, and for approaches to preventive intervention.