Mechanisms Underlying Emotion Regulation Abnormalities in Youth at Clinical High-Risk for Psychosis

项目摘要 精神障碍是一种严重的、使人衰弱的精神疾病，会给患者和 给我们的医疗保健系统带来了重大挑战。鉴于很少有人能在发病后恢复 在精神障碍方面，人们对早期识别和预防精神病越来越感兴趣。 精神障碍通常出现在前驱症状阶段，特征是功能衰退和 轻微的减弱症状，在几个月到几年的过程中逐渐恶化。这段时间 既是研究疾病发病过程的一个窗口，也是一个潜在的点 干预和预防。应力易损性模型仍然是关于其起源的主要理论之一。 精神错乱。然而，仅HPA轴功能障碍和应激反应增强仅是轻微的。 预测在慢性阻塞性肺疾病的年轻人中转化为精神病，并没有导致预防方面的突破。至 为早期干预开发新的目标，当前的项目旨在检验以下中心假设 情绪调节异常(即使用策略降低情绪调节强度或频率的能力 消极情绪)是一个易受伤害的因素，会增加患精神病的风险。我们建议 用格罗斯扩展过程的视角对情绪调节进行综合评价 情绪调节模型。该模型提出情绪调节涉及一系列阶段， 包括：识别(即，检测情绪并确定是否进行调节)、选择(即，选择 战略)和实施(即，执行所选战略)。我们的初步数据显示，患有糖尿病的成年人 精神分裂症(SZ)表明，这些阶段中的每个阶段的异常都会导致 幻觉和错觉。目前的应用程序建议将这一发现扩展到50克拉的年轻人和50克拉的年轻人 健康对照组，他们将完成一项由多模式情绪组合组成的横断面评估 调节实验室任务(行为、电生理学、眼球跟踪、瞳孔测量)和6天的生态 将提交给数学建模的瞬时评估(EMA)。这些数据将用于 完成以下具体目标：1)：评估应力-脆弱性模型并检验假设 减弱的精神病体验在时间上先于自主神经系统的异常。 反应性；2)确定CHR青年情绪调节的哪些阶段异常，并确定调节因素 3)确定情绪调节各阶段的异常是否预示着 并决定是否合并情绪调节异常和应激反应 会比单独预测两个变量中的任何一个更能预测精神病风险。这项研究的结果将有益于 通过确定特定的情绪调节过程，及早识别和预防 作为心理社会干预的目标。事实证明，这种干预措施对治疗其他疾病很有效， 但尚未在精神分裂症谱系中进行评估，以确定预防效果。

Project Summary Psychotic disorders are serious and debilitating mental illnesses that incur substantial suffering for patients and present major challenges to our health care system. Given that few individuals achieve recovery after the onset of a psychotic disorder, there is increasing interest in the early identification and prevention of psychosis. Psychotic disorders are typically preceded by a prodromal phase characterized by functional decline and subtle attenuated symptoms that progressively worsen over the course of several months to years. This period is of interest both as a window for investigating processes involved in disease onset and as a potential point of intervention and prevention. The stress-vulnerability model remains one of the leading theories on the origins of psychosis. However, dysfunctional HPA axis activity and heightened stress reactivity alone only modestly predicts conversion to psychosis among CHR youth and has not led to breakthroughs in prevention. To develop novel targets for early intervention, the current project aims to test the central hypothesis that abnormalities in emotion regulation (i.e., the ability to use strategies to decrease the intensity or frequency of negative emotion) are a vulnerability factor that increases risk for developing a psychotic disorder. We propose to conduct a comprehensive evaluation of emotion regulation through the lens of Gross’ extended process model of emotion regulation. This model proposes that emotion regulation involves a series of stages, including: identification (i.e., detecting emotion and determining whether to regulate), selection (i.e., choosing a strategy), and implementation (i.e., executing the selected strategy). Our preliminary data in adults with schizophrenia (SZ) indicates that abnormalities at each of these stages contribute to state fluctuations in hallucinations and delusions. The current application proposes to extend this finding to 50 CHR youth and 50 healthy controls who will complete a cross-sectional evaluation consisting of a multimodal battery of emotion regulation laboratory tasks (behavior, electrophysiology, eye tracking, pupillometry) and 6 days of ecological momentary assessment (EMA) that will be submitted to mathematical modeling. This data will be used to complete the following specific aims: 1): To evaluate the stress-vulnerability model and test the hypothesis that attenuated psychotic experiences are temporally preceded by abnormalities in autonomic nervous system reactivity; 2) To define which stages of emotion regulation are abnormal in CHR youth and identify moderators of each stage; 3) To identify whether abnormalities at each of the stages of emotion regulation are predictive of psychosis risk and determine whether the combination of emotion regulation abnormalities and stress reactivity will predict psychosis risk more so than either variable alone. Findings resulting from this study will benefit early identification and prevention efforts by identifying specific emotion regulation processes that can be targeted in psychosocial interventions. Such interventions have proven effective for treating other disorders, but have not yet been evaluated in the schizophrenia-spectrum to determine efficacy for prevention.