Development of a transdiagnostic intervention for adolescents at risk for serious mental illness

摘要 亚临床精神病症状是一种多潜能的跨诊断风险因素，与 随后发展为严重精神疾病(精神病或非精神病)和当前精神病的风险增加 苦恼。然而，试图在亚临床患者中预防这些慢性病的发病 精神病症状收效甚微。这可能是因为之前的大多数研究都集中在 相对较晚的风险阶段，此时疾病过程可能进展良好，因此更难 倒车。在生命的早期，在青春期--这段时间的特点是高水平的 神经可塑性-对于预防性干预特别重要，同时也解决了高度 目前迫切需要为青年提供更多的心理健康服务。 在过去的几年里，我们开发并测试了一种针对青少年的简短的、基于小组的干预措施 成人，称为复原力训练(RT)。RT侧重于增加支持社会功能的能力， 包括社会认知，准确感知他人和他们的神经心理过程 精神状态。当这些能力得到增强时，这种改进可能会导致较低的 精神变态学。在两个已发表的试验中，我们报告了RT导致一系列症状的减轻 和改善社会功能。此外，社会认知的改善，特别是心理理论方面的改善， 理解他人心理状态的能力与RT相关的精神疾病的减少有关 这一高危青年群体的症状和社会功能的改善。 基于这些先前的发现，拟议项目的目标是使RT适应于高危青少年 他们将通过在其高中进行的简短心理健康筛查来招募，这将确定 那些有亚临床精神病症状但尚未接受任何精神健康治疗的人。我们会 首先测试适应性干预在该人群中的可行性和可接受性，然后进行试点 随机、等待名单对照试验，以测试其在减少跨诊断症状和改善方面的有效性 社交功能。我们还将衡量拟议的干预目标机制、社会 认知，在任何与干预相关的改进中都发挥着作用。如果这个项目的假设得到证实， 随后将进行一项确定的、纵向的、随机的对照试验，该试验将衡量这种疗法的疗效。 预防易诊断高危青少年残疾的新干预措施。 在这个项目的过程中，在经验丰富的多学科的指导下 导师团队、课程安排和全面的培训计划，其中包括社会研究方面的培训 认知、青少年心理健康、纵向生物统计和干预适应，申请人将 培养必要的知识和技能，成为独立的干预研究人员，专注于 制定预防和治疗青少年严重精神疾病的方法。

Summary Subclinical psychotic symptoms are a pluripotent transdiagnostic risk factor, associated both with an increased risk of subsequently developing a serious mental illness (psychotic or non) and current psychiatric distress. However, attempts to prevent the onset of these chronic illnesses in individuals with subclinical psychotic symptoms have had limited success. This may be due to the majority of prior studies focusing on a relatively late stage of risk, when the illness processes are possibly well underway and thus more difficult to reverse. Intervening earlier in the lifespan, during adolescence - a time characterized by high levels of neuroplasticity - could be particularly important for preventive interventions, while also addressing the highly pressing current need for more mental health services for youth. During the past few years, we have developed and tested a brief, group-based intervention for young adults, called Resilience Training (RT). RT focuses on increasing capacities that support social functioning, including social cognition, the neuropsychological processes involved in accurately perceiving others and their mental states. When these capacities are enhanced, such improvements may lead to lower rates of psychopathology. In two published trials, we have reported that RT led to reductions in a range of symptoms and improved social functioning. Additionally, improvements in social cognition, particularly in Theory of Mind, the ability to understand the mental states of others, are linked to RT-related decreases in psychiatric symptoms and improvements in social functioning in this at-risk young adult group. Based on these prior findings, the goal of the proposed project is to adapt RT for at-risk adolescents who will be recruited using a brief mental health screening administered in their high schools, which will identify those who have subclinical psychotic symptoms but are not yet receiving any mental health treatment. We will first test the adapted intervention for its feasibility and acceptability in this population, and then conduct a pilot randomized, waitlist-controlled trial, to test for its efficacy in reducing transdiagnostic symptoms and improving social functioning. We will also measure whether the proposed target mechanism of the intervention, social cognition, plays a role in any intervention-related improvements. If the hypotheses of this project are confirmed, it will be followed by a definitive, longitudinal, randomized control trial, which will measure the efficacy of this novel intervention for preventing disability in transdiagnostically at-risk adolescents. During the course of this project, with the guidance of a highly experienced multi-disciplinary mentorship team, coursework, and a comprehensive training plan that involves training in research on social cognition, adolescent mental health, longitudinal biostatistics, and intervention adaptation, the applicant will develop the necessary knowledge and skills to become an independent intervention researcher, focused on developing approaches for the prevention and treatment of serious mental illnesses in young people.