Trajectories of recovery from psychosis over two decades

二十年来精神病康复的轨迹

• 批准号: 8447056
• 负责人: Roman I Kotov
• 金额: $ 57.74万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-07 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8447056
• 关键词: Academic Medical Centers; Address; Admission activity; Algorithms; Benchmarking; Bipolar Disorder; Caring; Characteristics; Clinical; Clinical Research; Cognitive; Communities; Consensus; Control Groups; County; Data; Dental; Development; Diagnosis; Diagnostic; Disease; Disease remission; Employment; Epidemiologic Studies; Epidemiology; Event-Related Potentials; Evolution; Exhibits; Foundations; Freedom; Functional disorder; Health Policy; Homelessness; Hospitalization; Impairment; Imprisonment; Individual; Inpatients; Intervention; Interview; Lead; Life; Link; Measures; Medical; Medical Records; Mental Health; Mood Disorders; National Institute of Mental Health; Neurobiology; Occupational; Outcome; Participant; Patients; Performance; Phase; Policies; Population; Prevalence; Psychiatrist; Psychotic Disorders; Public Health; Recovery; Recruitment Activity; Relative (related person); Reporting; Research; Research Design; Rest; Risk; Sampling; Schizophrenia; Shapes; Strategic Planning; Targeted Research; Testing; Time; Unemployment; affective psychoses; clinical practice; cohort; design; disability; epidemiologic data; experience; follow-up; improved functioning; information processing; member; multi-component intervention; neuropsychological; novel; outcome forecast; psychotic depression; response; severe mental illness; social; sound; treatment as usual

DESCRIPTION (provided by applicant): This proposed study will investigate the trajectories of recovery over the two decades after first admission in a large representative sample of affective and non-affective psychoses, the only such cohort followed long-term in the US. The proposed study will provide epidemiologic data on prevalence, distribution, and development of long-term recovery. Such information is essential for sound planning of the public health policy and accurate prognostication in clinical settings, but it is currently lacking. We will examine recovery across its many facets, including clinical, occupational, financial, social, cognitive, neurobiological, subjective, and consumer-defined domains. We also will investigate a range of potential predictors of recovery and will develop algorithms to help clinicians identify patients at risk for poor outcomes. Similarly, we will investigate other problems of high public health significance (e.g., homelessness, incarceration, and medical conditions). Furthermore, we will document the extent of unmet need for care in this population. The application is aligned with the NIMH Strategic Plan in seeking to (1) chart trajectories of psychotic disorders from an early phase of the illness and (2) elucidate links between neurobiological functioning and real-world performance in these conditions. The cohort was originally recruited in the early 1990s from all of the inpatient facilities in a large county and was interviewed multiple times over a 10-year period. At each point, study psychiatrists formulated consensus longitudinal diagnoses. At the 10-year mark, we interviewed 470 cohort members (80.2% response rate), and we found that many had not achieved recovery. However, it has long been hypothesized that functioning improves during the second decade of the illness. Moreover, growing availability of recovery-oriented treatments over the last 10 years is expected to bolster rates of recovery. These predictions will be tested by assessing the cohort two decades after the first hospitalization. A major challenge in studying recovery is the lack of empirical benchmarks for defining it. To address this problem, we will recruit a demographically-matched control group and use its performance to anchor outcomes. We plan to assess 425 cohort members and 425 controls using a state-of-the-art battery of measures. We will interview participants and relatives, review medical records, and administer neuropsychological and electrophysiological assessments. This design offers statistical power to detect even small changes in functioning and will produce normative data that will enable this and other studies to define recovery with rigor and precision. This will be the first study to investigate long-term recovery from psychosis in an epidemiologic first-admission sample and provide an unbiased picture of the scope of the problem.

描述（由申请人提供）：这项拟议的研究将研究在大量代表性的情感和非情感精神病样本中首次入院后的二十年中的恢复轨迹，这是美国唯一的长期遵循的。拟议的研究将提供有关长期恢复的流行，分布和发展的流行病学数据。这些信息对于公共卫生政策的合理规划和在临床环境中的准确预后至关重要，但目前缺乏。我们将研究其许多方面的恢复，包括临床，职业，财务，社会，认知，神经生物学，主观和消费者定义的领域。我们还将研究恢复的一系列潜在预测指标，并将开发算法，以帮助临床医生识别出较差预后的患者。同样，我们将研究其他具有高公共卫生意义的问题（例如无家可归，监禁和医疗状况）。此外，我们将记录该人群中未满足的护理需求的程度。该应用与NIMH战略计划一致，以寻求（1）疾病早期阶段的精神疾病轨迹，以及（2）在这些疾病中阐明神经生物学功能和现实世界表现之间的联系。该队列最初是在1990年代初从一个大县的所有住院设施中招募的，并在10年的时间内接受了多次采访。在每个时刻，研究精神科医生都提出了共识纵向诊断。在10年期间，我们采访了470名队列成员（回应率为80.2％），我们发现许多人没有实现康复。但是，长期以来，人们一直认为，在疾病的第二个十年中的功能会有所改善。此外，在过去的10年中，预计以恢复为导向的治疗的可用性将增强恢复率。这些预测将通过评估第一次住院后的二十年来评估该队列。研究恢复的主要挑战是缺乏定义它的经验基准。为了解决这个问题，我们将招募一个人口统计学匹配的对照组，并使用其绩效来锚定结果。我们计划使用最先进的措施评估425个队列成员和425个对照。我们将采访参与者和亲戚，审查病历，并管理神经心理学和电生理评估。该设计提供了统计能力，甚至可以检测到功能的少量变化，并将产生规范性数据，从而使该研究能够以严格和精确的态度定义恢复。这将是第一项研究在流行病学的第一屈服样本中长期从精神病中恢复的研究，并提供了问题范围的无偏见。

项目成果

Transdiagnostic neural markers of emotion-cognition interaction in psychotic disorders.

• DOI: 10.1037/abn0000196
• 发表时间: 2016-10
• 期刊: Journal of abnormal psychology
• 影响因子: 4.6
• 作者: Sabharwal A;Szekely A;Kotov R;Mukherjee P;Leung HC;Barch DM;Mohanty A
• 通讯作者: Mohanty A

Diagnostic consistency of major depression with psychosis across 10 years.

• DOI: 10.4088/jcp.10m06774
• 发表时间: 2011-09
• 期刊: The Journal of clinical psychiatry
• 作者: Ruggero CJ;Kotov R;Carlson GA;Tanenberg-Karant M;González DA;Bromet EJ
• 通讯作者: Bromet EJ

Schizophrenia in the Internalizing-Externalizing Framework: A Third Dimension?

• DOI: 10.1093/schbul/sbq024
• 发表时间: 2011-11-01
• 期刊: SCHIZOPHRENIA BULLETIN
• 影响因子: 6.6
• 作者: Kotov, Roman;Chang, Su-Wei;Bromet, Evelyn J.
• 通讯作者: Bromet, Evelyn J.

Ten-year diagnostic consistency of bipolar disorder in a first-admission sample.

首次入院样本中双相情感障碍的十年诊断一致性。

• DOI: 10.1111/j.1399-5618.2009.00777.x
• 发表时间: 2010
• 期刊: Bipolar disorders
• 影响因子: 5.4
• 作者: Ruggero,CamiloJ;Carlson,GabrielleA;Kotov,Roman;Bromet,EvelynJ
• 通讯作者: Bromet,EvelynJ

Clinical significance of auditory target P300 subcomponents in psychosis: Differential diagnosis, symptom profiles, and course.

• DOI: 10.1016/j.schres.2015.04.013
• 发表时间: 2015-07
• 期刊: SCHIZOPHRENIA RESEARCH
• 影响因子: 4.5
• 作者: Perlman, Greg;Foti, Dan;Jackson, Felicia;Kotov, Roman;Constantino, Eduardo;Hajcak, Greg
• 通讯作者: Hajcak, Greg