Trajectories of recovery from psychosis over two decades

描述（由申请人提供）：这项拟议的研究将调查情感性和非情感性精神病的大型代表性样本首次入院后20年内的恢复轨迹，这是美国唯一一个长期随访的此类队列。拟议的研究将提供流行病学数据的患病率，分布和发展的长期恢复。这些信息对于公共卫生政策的合理规划和临床环境中的准确诊断至关重要，但目前缺乏。我们将从多个方面研究康复，包括临床、职业、财务、社会、认知、神经生物学、主观和消费者定义的领域。我们还将调查一系列潜在的康复预测因素，并将开发算法来帮助临床医生识别有不良结局风险的患者。同样，我们将调查其他具有高度公共卫生意义的问题（例如，无家可归，监禁和医疗条件）。此外，我们将记录这一人群中未满足的护理需求的程度。该应用程序与NIMH战略计划保持一致，旨在（1）从疾病的早期阶段绘制精神障碍的轨迹，（2）阐明这些条件下神经生物学功能与现实世界表现之间的联系。该队列最初于20世纪90年代初从一个大县的所有住院设施招募，并在10年内多次接受采访。在每一点上，研究精神病学家制定了一致的纵向诊断。在10年的时间里，我们采访了470名队列成员（80.2%的应答率），我们发现许多人没有实现康复。然而，长期以来一直假设功能在疾病的第二个十年期间得到改善。此外，在过去10年中，以恢复为导向的治疗方法越来越多，预计将提高恢复率。这些预测将通过评估首次住院后20年的队列进行检验。研究复苏的一个主要挑战是缺乏定义它的经验基准。为了解决这个问题，我们将招募一个人口统计学上匹配的对照组，并使用其表现来锚定结果。我们计划使用最先进的一组测量方法评估425名队列成员和425名对照。我们将采访参与者和亲属，审查医疗记录，并进行神经心理学和电生理学评估。这种设计提供了统计能力来检测功能的微小变化，并将产生规范性数据，使本研究和其他研究能够严格和精确地定义恢复。这将是第一项研究，以调查长期恢复精神病的流行病学首次入院样本，并提供了一个公正的图片的范围内的问题。

DESCRIPTION (provided by applicant): This proposed study will investigate the trajectories of recovery over the two decades after first admission in a large representative sample of affective and non-affective psychoses, the only such cohort followed long-term in the US. The proposed study will provide epidemiologic data on prevalence, distribution, and development of long-term recovery. Such information is essential for sound planning of the public health policy and accurate prognostication in clinical settings, but it is currently lacking. We will examine recovery across its many facets, including clinical, occupational, financial, social, cognitive, neurobiological, subjective, and consumer-defined domains. We also will investigate a range of potential predictors of recovery and will develop algorithms to help clinicians identify patients at risk for poor outcomes. Similarly, we will investigate other problems of high public health significance (e.g., homelessness, incarceration, and medical conditions). Furthermore, we will document the extent of unmet need for care in this population. The application is aligned with the NIMH Strategic Plan in seeking to (1) chart trajectories of psychotic disorders from an early phase of the illness and (2) elucidate links between neurobiological functioning and real-world performance in these conditions. The cohort was originally recruited in the early 1990s from all of the inpatient facilities in a large county and was interviewed multiple times over a 10-year period. At each point, study psychiatrists formulated consensus longitudinal diagnoses. At the 10-year mark, we interviewed 470 cohort members (80.2% response rate), and we found that many had not achieved recovery. However, it has long been hypothesized that functioning improves during the second decade of the illness. Moreover, growing availability of recovery-oriented treatments over the last 10 years is expected to bolster rates of recovery. These predictions will be tested by assessing the cohort two decades after the first hospitalization. A major challenge in studying recovery is the lack of empirical benchmarks for defining it. To address this problem, we will recruit a demographically-matched control group and use its performance to anchor outcomes. We plan to assess 425 cohort members and 425 controls using a state-of-the-art battery of measures. We will interview participants and relatives, review medical records, and administer neuropsychological and electrophysiological assessments. This design offers statistical power to detect even small changes in functioning and will produce normative data that will enable this and other studies to define recovery with rigor and precision. This will be the first study to investigate long-term recovery from psychosis in an epidemiologic first-admission sample and provide an unbiased picture of the scope of the problem.