Trajectories of recovery from psychosis over two decades

描述(申请人提供)：这项拟议的研究将调查首次入院后20年内情感性和非情感性精神病的康复轨迹，这是唯一在美国长期跟踪的具有代表性的样本。拟议的研究将提供有关长期康复的流行率、分布和发展的流行病学数据。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预测至关重要，但目前缺乏这些信息。我们将研究康复的许多方面，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预后风险的患者。同样，我们将调查其他对公共卫生具有高度重要性的问题(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得到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，以寻求(1)绘制疾病早期精神障碍的轨迹图，以及(2)阐明在这些条件下神经生物学功能和现实世界表现之间的联系。这个队列最初是在20世纪90年代初从一个大县的所有住院设施中招募的，在10年的时间里接受了多次采访。在每一个时间点上，研究精神病学家都制定了一致的纵向诊断。在10年的时候，我们采访了470名队列成员(回复率为80.2%)，我们发现许多人还没有恢复。然而，长期以来，人们一直假设，在疾病的第二个十年里，功能会有所改善。此外，在过去10年里，越来越多的以康复为导向的治疗方法的可获得性有望提高恢复率。这些预测将通过在首次住院20年后对队列进行评估来验证。研究复苏的一大挑战是缺乏定义复苏的经验基准。为了解决这个问题，我们将招募一个与人口统计学相匹配的对照组，并利用他们的表现来确定结果。我们计划使用最先进的一系列措施来评估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，并进行神经心理和电生理评估。这一设计提供了检测功能微小变化的统计能力，并将产生标准化数据，使这项研究和其他研究能够严格和精确地确定恢复情况。这将是第一项在流行病学首次入院样本中调查精神病长期康复情况的研究，并提供对问题范围的公正描述。

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.