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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Center Core Grants (P30)
Project #
3P30MH090590-03S1
Application #
8507854
Study Section
Special Emphasis Panel (ZMH1-ERB-N)
Project Start
Project End
Budget Start
2012-07-18
Budget End
2013-04-30
Support Year
3
Fiscal Year
2012
Total Cost
$18,320
Indirect Cost
$7,230
Name
Feinstein Institute for Medical Research
Department
Type
DUNS #
110565913
City
Manhasset
State
NY
Country
United States
Zip Code
11030
Kishimoto, T; Chawla, J M; Hagi, K et al. (2016) Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety and time trajectories. Psychol Med 46:1459-72
Galling, Britta; Roldán, Alexandra; Nielsen, René E et al. (2016) Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics: A Systematic Review and Meta-analysis. JAMA Psychiatry 73:247-59
Kane, John M; Robinson, Delbert G; Schooler, Nina R et al. (2016) Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. Am J Psychiatry 173:362-72
Sarpal, Deepak K; Lencz, Todd; Malhotra, Anil K (2016) In Support of Neuroimaging Biomarkers of Treatment Response in First-Episode Schizophrenia. Am J Psychiatry 173:732-3
Sarpal, Deepak K; Argyelan, Miklos; Robinson, Delbert G et al. (2016) Baseline Striatal Functional Connectivity as a Predictor of Response to Antipsychotic Drug Treatment. Am J Psychiatry 173:69-77
Robinson, Delbert G; Gallego, Juan A; John, Majnu et al. (2015) A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes. Schizophr Bull 41:1227-36
Galling, Britta; Correll, Christoph U (2015) Do antipsychotics increase diabetes risk in children and adolescents? Expert Opin Drug Saf 14:219-41
Zhang, Jian-Ping; Robinson, Delbert G; Gallego, Juan A et al. (2015) Association of a Schizophrenia Risk Variant at the DRD2 Locus With Antipsychotic Treatment Response in First-Episode Psychosis. Schizophr Bull 41:1248-55
Gerstenberg, Miriam; Hauser, Marta; Al-Jadiri, Aseel et al. (2015) Frequency and correlates of DSM-5 attenuated psychosis syndrome in a sample of adolescent inpatients with nonpsychotic psychiatric disorders. J Clin Psychiatry 76:e1449-58
Jensen, Karsten Gjessing; Juul, Klaus; Fink-Jensen, Anders et al. (2015) Corrected QT changes during antipsychotic treatment of children and adolescents: a systematic review and meta-analysis of clinical trials. J Am Acad Child Adolesc Psychiatry 54:25-36

Showing the most recent 10 out of 69 publications