Ambulatory Monitoring of Threat Dysregulation in Adolescents at Risk for Psychosis

对有精神病风险的青少年威胁失调的动态监测

• 批准号: 10202459
• 负责人: LESLIE E HORTON
• 金额: $ 60.2万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10202459
• 关键词: Acute; Address; Adolescence; Adolescent; Affect; Affective; Age; Ambulatory Monitoring; Arousal; Autonomic nervous system; Award; Biological Process; Cardiac; Cardiovascular system; Cellular Phone; Chronic; Clinical; Clinical assessments; Cognitive; Congenital neurologic anomalies; Development; Diagnostic; Disease susceptibility; Early identification; Early treatment; Ecological momentary assessment; Emotional; Exhibits; Fright; Goals; Home; Hydrocortisone; Impairment; In Vitro; Individual; Investigation; Laboratories; Life; Link; Literature; Measures; Mediating; Methods; Modeling; National Institute of Mental Health; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Play; Procedures; Psychopathology; Psychophysiology; Psychoses; Psychotic Disorders; Recovery; Research; Research Domain Criteria; Rest; Risk; Role; Sampling; Schizophrenia; Sex Differences; Social Functioning; Social Processes; Stress; System; Technology; Testing; Theoretical model; Time; Visit; Youth; age difference; age group; aged; base; biological adaptation to stress; clinically relevant; disability; experience; follow up assessment; high risk; hypothalamic-pituitary-adrenal axis; improved; in vivo; innovation; longitudinal design; mortality; multimodality; negative affect; novel; preventive intervention; psychotic symptoms; recruit; research clinical testing; response; sex; social; social relationships; stressor; wearable device

PROJECT ABSTRACT The proposed study seeks to examine the role of physiological threat dysregulation (TD) as a contributor to social impairment and psychotic-like experiences in youth at-risk for psychosis, and further examine the extent to which faulty cognitive and affective threat responses play a role in partially mediating this relationship. Although the “diathesis-stress model” is a well-established framework for the onset of psychosis and other forms of psychopathology, the exact mechanism as it applies to psychosis remains unclear. This is an important mechanism to examine because TD can generate chronic fear and arousal, states which interfere with social relationships and healthy development. The proposed study will address this gap in the literature by comprehensively examining physiological TD, including the function of the Hypothalamic-Pituitary-Adrenal (HPA) axis and the Autonomic Nervous System (ANS). The current proposal uses multiple methods, including laboratory assessments, ecological momentary assessment (EMA), and ambulatory psychophysiology, to examine the link between TD and outcomes in the laboratory and in daily life. This proposal will utilize a longitudinal design to examine how TD is associated with the persistence or worsening of social impairment and psychotic-like experiences over 1 year. Given that the post-pubertal adolescent developmental stage is a sensitive period for the development of psychotic disorders, we propose to recruit a post-pubertal (age 14-17) sample of adolescents at clinical high-risk for psychosis (CHR; n = 105) and a group of age- and sex-matched controls (n = 70). Multi-method assessments will include 3 laboratory visits (Baseline, 6 months, and 1 year later) with clinical assessments and evaluation of TD before, during, and after a social threat induction task. Visits will be followed by 2 weeks of at-home EMA to investigate real-time ANS threat response (via cardiac wearable device), social impairment, stress, and psychotic-like experiences (via smartphone self-report). The proposed study would be novel in that it will to pair EMA with cutting-edge, ambulatory cardiovascular psychophysiology assessment. Thus, this proposal would unite established in vitro (laboratory) assessments of key variables with novel in vivo (EMA) assessments, the latter of which have high ecological and clinical validity. The aims of the project match well with the strategic goals of the National Institute of Mental Health (NIMH); in particular, Strategies 2 and 3. The proposed conceptual model is highly relevant to the NIMH Research Domain Criteria (RDoC) domains of the sustained and acute threat systems, as well as the “social processes” domain; thus, this research should have relevance to the study of psychopathology across diagnostic boundaries. The proposed award should 1) provide precision to investigation of a theoretical model of TD and its impacts on social impairment and psychotic-like experiences, 2) contribute to the development of an EMA- based “early warning system” to predict changes in psychosis, and 3) suggest new directions for improved prevention and intervention strategies for adolescents at-risk for psychosis.

项目摘要 拟议的研究旨在研究物理威胁失调（TD）的作用 社会障碍和类似精神病的人在危险中患有精神病，并进一步检查 有缺陷的认知和情感威胁反应在部分调解这种关系中起作用。 虽然“透明压力模型”是精神病和其他精神病发作的完善框架 精神病理学的形式，适用于精神病的确切机制尚不清楚。这是一个重要的 要检查的机制是因为TD可以产生慢性恐惧和唤醒，该州干涉社会 人际关系和健康发展。拟议的研究将解决文献中的这一差距 全面检查物理TD，包括下丘脑 - 垂体 - 肾上腺的功能 （HPA）轴和自主神经系统（ANS）。当前建议使用多种方法，包括 实验室评估，生态瞬时评估（EMA）和卧床心理生理学， 检查实验室和日常生活中TD与结果之间的联系。该建议将利用 纵向设计，以检查TD与社会障碍的持久性或担心如何相关 和类似精神病的经历超过1年。鉴于后青春期后的发展阶段是 为了发展精神病疾病的敏感时期，我们建议招募一名赛后（14-17岁） 临床高风险的青少年样本（chr; n = 105）和一组年龄和性别匹配的样本 控件（n = 70）。多方法评估将包括3次实验室访问（基线，6个月和1年 稍后）进行临床评估和对TD的临床评估，此前，期间和之后的社会威胁归纳任务。 访问将随后进行2周的家庭EMA，以调查实时ANS威胁响应（通过心脏 可穿戴设备），社交障碍，压力和类似精神病性的体验（通过智能手机自我报告）。 拟议的研究将是新颖的，因为它将将EMA与尖端的卧床心血管配对 心理生理评估。这就是该提议将在体外（实验室）评估中团结 新型体内（EMA）评估的关键变量，后者的生态和临床高 有效性。该项目的目的与国家心理健康研究所的战略目标非常吻合 （nimh）;尤其是策略2和3。拟议的概念模型与NIMH高度相关 持续和急性威胁系统的研究领域标准（RDOC）领域以及“社会 过程”领域；因此，这项研究应与诊断范围内的心理病理学研究有关 边界。拟议的裁决应为1）精确调查TD的理论模型和 它对社会障碍和类似精神病的经历的影响，2）有助于发展EMA- 基于预测精神病变化的“预警系统”，3）提出了改进的新方向 青少年在危险中的预防和干预策略。