Clinical Assessment Strategies Unit Diagnosis in early phase patients is more complex and uncertain, yet treatment decisions at this stage can have important consequences (both positive and negative). Age and developmental issues complicate the assessment of clinical response and adverse effects (e.g. weight gain, sexual side effects and neuroendocrine abnormalities), as well as the interpretation of cognitive and neuroimaging data. Recognition has increased throughout the field that social and role (academic/occupational) functioning are critical components of the illness process that severely limit prognosis. It is, therefore, essential to identify functional deficits and characterize their developmental course as early as possible to develop optimum early interventions. Adherence Unit Adherence in medication-taking as well as following overall treatment recommendations is a critical variable in treatment response and outcome (particularly long term). The challenges of accepting the reality and implications of a potentially devastating illness, as well as accepting the need to take (often stigmatizing) medication with significant adverse effects are particularly difficult for adolescents and young adults. It is critical to develop and test strategies with these populations in mind. In addition, we must address the added challenge of illness phases in which there can remain considerable uncertainty as to the diagnosis. Adverse Effects Unit The diagnosis, management and prevention of adverse effects in early phase psychosis is enormously important. First, the populations in which we are focusing have enormous reluctance/ambivalence about medication from the outset. Second, their vulnerabilities to and the consequences of metabolic and endocrine adverse effects might differ in important ways from adult and more chronic populations. Third, long-term pharmacotherapy beginning at a young age likely means considerable chronic exposure to these medications. Although the Adverse Events Unit is conducting studies and analyzing data across the age range, we have a particular focus on the implications for adolescents and young adults with psychotic disorders. Biomarkers Unit The challenges in using biomarkers in these populations require special attention and provide unique opportunities. The potential to examine the role of biomarkers in illness presentation and treatment response is particularly valuable in early phase illness before a variety of confounding factors may come into play. In neuroimaging and cognition, there are special considerations for the developing brain that the Biomarkers Unit has special expertise in assessing.

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National Institute of Mental Health (NIMH)
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Feinstein Institute for Medical Research
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