Department of Neuropsychiatry, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan.
Schizophr Res. 2013 Jan;143(1):116-24. doi: 10.1016/j.schres.2012.11.012. Epub 2012 Dec 4.
Longitudinal clinical investigations and biological measurements have determined not only progressive brain volumetric and functional changes especially around the onset of psychosis but also the abnormality of developmental pathways based on gene-environment interaction model. However, these studies have contributed little to clinical decisions on their diagnosis and therapeutic choices because of subtle differences between patients and healthy controls. A multi-modal approach may resolve this limitation and is favorable to explore the pathophysiology of psychosis. The integrative neuroimaging studies for schizophrenia targeting early intervention and prevention (IN-STEP) is a research project aimed at exploring the pathophysiological features of the onset of psychosis and investigating possible predictive biomarkers for the clinical treatment of psychosis. Since 2008, we have adopted blood sampling, neurocognitive batteries, neurophysiological assessment, structural imaging, and functional imaging longitudinally for help-seeking ultra-high-risk (UHR) individuals and patients with first-episode psychosis (FEP). Here, we intend to introduce the IN-STEP research study protocol and present preliminary clinical findings. Thirty-seven UHR individuals and 30 patients with FEP participated in this study. Six months later, there was no difference in objective and subjective scores between the groups, which suggests that young people having symptoms and functional deficits should be cared for regardless of their history of psychosis according to their clinical stages. The rate of transition to psychosis was 7.1%, 8.0%, and 35.3% (at 6, 12, and 24months, respectively). Through this research project, we expect to clarify the pathophysiological features around the onset of psychosis and improve the prognosis of psychosis through clinical application.
纵向临床研究和生物学测量不仅确定了在精神病发作前后大脑体积和功能的进行性变化，而且还确定了基于基因-环境相互作用模型的发育途径的异常。然而，由于患者和健康对照组之间存在细微差异，这些研究对其诊断和治疗选择的临床决策几乎没有贡献。多模态方法可能会解决这一局限性，并有利于探索精神病的病理生理学。针对精神病早期干预和预防的综合神经影像学研究（IN-STEP）是一个旨在探索精神病发作的病理生理学特征以及研究精神病临床治疗可能的预测生物标志物的研究项目。自 2008 年以来，我们一直对寻求帮助的超高风险（UHR）个体和首发精神病（FEP）患者进行血液采样、神经认知测试、神经生理学评估、结构成像和功能成像的纵向研究。在这里，我们旨在介绍 IN-STEP 研究方案，并介绍初步的临床发现。37 名 UHR 个体和 30 名 FEP 患者参与了这项研究。6 个月后，两组之间的客观和主观评分没有差异，这表明，有症状和功能缺陷的年轻人应该根据其临床阶段，无论其是否有精神病病史，都应得到照顾。精神病转化率分别为 7.1%、8.0%和 35.3%（分别在 6、12 和 24 个月时）。通过这个研究项目，我们希望阐明精神病发作前后的病理生理学特征，并通过临床应用改善精神病的预后。
