My hypotheses about schizophrenia (S) are that the vulnerability to psychosis leads to a neurobiological deterioration in early adulthood which, in turn, leads to chronicity. Accumulating evidence suggests that this process, though unknown, may be truncated by early application of existing treatments soon after onset or even before onset in the prodromal phase. During my past 8 years as the Director of a psychiatric teaching hospital I have pursued the study of schizotypy and S and initiated three ongoing investigations as PI: 1) Collaborative Longitudinal Study of Personality Disorders (PD). Begun in 1996, this 5 year project is a collaborative five site longitudinal descriptive study of four personality disorders, including schizotypal PD. 2) Early Detection and Intervention in Schizophrenia. Begun in 1997, this 4 year Scandinavian project tests whether public education about the early signs of psychosis can reduce the duration of untreated psychosis in first episode schizophrenia and whether such a reduction can improve the progress of the disorder. 3) Delaying or Preventing Psychosis: A Clinical Trial of Treatment in Persons Prodromal to Psychosis. Begun in late 1997, this New Haven pilot project aims to identify people who are prodromal to psychosis and recruit them into a double blind, placebo controlled clinical trial of an atypical neuroleptic, the aim being primary and/or secondary prevention of psychosis. A successful pilot will lead to a larger 4 year study. With the Senior Scientist Award I will be released from my current administrative responsibilities. It would allow me 80 percent time to pursue research on a full time basis in the Yale Department of Psychiatry as the PI of Early Detection and Intervention Studies of Psychosis. The Chairman of Psychiatry has assured me of the Department's commitment to my research plans and to making available resources from the MHCRC as necessary. With the Award I will attend intensively to my current projects which are growing in size and value and require much more time than I am now able to invest. I will also pursue the development of two more studies as follows: 4) Ascertaining the frequency, nature, and consequences of prodromal states in Schizotypal Personality Disorder and 5) The epidemiology of prodromal states in first degree relatives of schizophrenic patients in Finland.
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