Biomarkers Unit (Research Methods Core)

早期精神病和假定的前驱状态代表着巨大的挑战和机遇。 这些挑战包括年龄范围内的诊断不确定性，这对成熟和个性化至关重要，并充满了心理和社会压力。这些机会包括适当、有效和持续地进行干预的能力，以便对个人和公众产生长期的深刻影响。 健康疾病的后果。 在我们的主要研究核心中，我们正在/将在这方面进行一系列广泛的研究。主题是为治疗决策提供信息，这也需要涉及运营核心中的所有单位 作为方法核心中的单元。 我们选择了几项符合R-34类开发项目描述的计划研究作为例子。正如方案公告所建议的那样，这些项目旨在提供初步数据，以指导未来更明确的调查设计。我们选择了一些例子来说明中心研究人员将根据我们的主题解决的相关但不同的问题。我们还提供了一系列精选的计划中的研究，特别是那些涉及年轻研究者的研究。 抗抑郁药在治疗假定的精神分裂症前驱症状中的潜在作用的研究将提供对照数据，随后在开放的自然主义治疗中获得令人兴奋的发现。另外这款 试验的结果将涉及到依从性问题，因为我们发现目标人群更容易接受抗抑郁药而不是抗精神病药。它还涉及不良反应的挑战，因为抗抑郁药与抗精神病药相比具有非常不同的风险特征。临床的作用 评估单元在识别适当的受试者方面至关重要，而且还确保充分捕获与对一类药剂或另一类药剂的优先反应相关的任何临床预测因子。类似地，生物标志物单元可以帮助告知生物和其他预测因子以及介导变量，其最终将 为治疗决策提供信息，并为基本机制提供线索。 物质诱发的精神障碍的治疗尚未得到足够的重视。这些人是否需要抗精神病药物治疗以防止精神病复发？事实上，这些人是否对精神障碍具有高度的脆弱性/素质？该中心的所有单位都在解决这个问题方面发挥作用，该中心的项目和数据库有助于与前驱症状和/或精神病患者进行重要的比较，这些患者的前驱症状和/或精神病并没有因似乎使用物质而沉淀出精神病体征和症状而复杂化。 类似地，双相情感障碍的年轻个体中精神病性症状的存在提出了关于诊断和诊断稳定性的问题，以及关于影响该人群的潜在长期使用问题的重要决定。 同样，生物标志物和临床预测因子在这种情况下的潜在作用不能过分强调。一个纵向数据库的可用性良好的特点双相情感障碍患者的精神障碍，使我们能够使用轨迹和症状为基础的聚类，除了传统的诊断方法。在任何可能使用影响体重调节和代谢参数的药物的情况下，我们需要更好地了解预防和管理策略。我们选择了一个特别脆弱（在许多层面上）的人群（即早发性精神分裂症）来研究降低风险的策略。 该项目还利用了该中心所有单位的资源和指导，这些数据将在管理任何可能接受影响代谢药物治疗的患者方面具有价值。 最后，我们提出了一个项目，重点是方法的进步，涉及发展一个适当的功能电池的早期阶段的疾病。该电池涉及社会和角色功能的评估，利用能力与成就的措施来区分介导早期患者功能障碍的关键方面。

Early phase psychotic illness and putative prodromal states represent enormous challenges and opportunities. The challenges include diagnostic uncertainty in an age range which is critical to maturation and individuation and fraught with psychological and social stresses. The opportunities include the ability to intervene appropriately, effectively and consistently in order to have a profound impact on long-term individual and public health disease consequences. In our Principal Research Core we are/will be conducting an extensive series of studies in this context. The theme is to inform treatment decisions and this requires involving all of the units in the Operations Core as well as the units in the Methods Core. We have selected to present, as examples, several planned studies which fit the description of R-34-like development projects. These projects, as suggested by the Program Announcement, are intended to provide preliminary data to guide the design of future, more definitive investigations. We have selected examples which illustrate the range of related, but distinct, issues that Center investigators will address in keeping with our theme. We have also provided a selected array of planned pil ot studies, particulariy those involving young investigators. The study of the potential role of antidepressants in the treatment of the putative schizophrenia prodrome will provide controlled data following up exciting findings obtained in open naturalistic treatment. In addition, this trial and it's results will relate to the adherence issue in that we have found the target population to be more accepting of antidepressants than of antipsychotics. It also relates to the adverse effects challenges, because antidepressants have very different risk profiles compared to antipsychotics. The role of the clinical assessment unit is critical in both identifying appropriate subjects, but also ensuring that any clinical predictors associated with preferential response to one class of agents or another are well-captured. Similariy, the biomarker unit can help to inform biological and other predictors and mediating variables which will ultimately inform treatment decisions and provide clues to basic mechanism(s). The treatment of substance-induced psychotic disorder has not received adequate attention. Do such individuals require antipsychotic treatment to prevent recurrence of psychosis? Are these in fact, individuals with a heightened vulnerability/diathesis toward psychotic disorders? All of the units in the Center come into play in addressing this question and the Center projects and data base facilitate important comparisons with patients whose prodromal symptoms and/or psychoses are not complicated by seeming substance use precipitation of psychotic signs and symptoms. Similariy, the presence of psychotic symptoms in young individuals with bipolar disorder raises questions about diagnosis and diagnostic stability as well as important decisions about the potential long-term use of issues affecting this population. Again the potential role of biomarkers and clinical predictors in this context cannot be overemphasized. The availability of a longitudinal data base on well-characterized bipolar patients with psychotic disorders enables us to use trajectory and symptom based clustering in addition to traditional diagnostic approaches. In any situation where drugs which affect weight regulation and metabolic parameter are potentially used, we need to have a better understanding of preventive and management strategies. We have chosen a particularly vulnerable (on many levels) population (i.e. early onset schizophrenia) to study a strategy or risk reduction. This project also draws on the resources and guidance of all of the Center's Units, and the data will be valuable in managing any patients who might be treated with drugs affecting metabolism. Finally, we propose a project focusing on method advancement that involves the development of an appropriate functional battery for eariy phase illness. This battery involves the assessment of both social and role functioning, utilizing measures of competence versus achievement to differentiate key aspects mediating functional disability in eariy phase patients.