Current and Developing Studies
Brain imaging in APS and early psychosis
In July of last year, the National Institute of Mental Health awarded us a $428,000 grant to conduct brain imaging studies of persons with early psychosis and APS. Funding was possible for this study because of the basic infrastructure support available to us, and the 2-year grant has allowed us to enhance our operations in the service of PREP goals. The brain imaging study is using magnetic resonance spectroscopy (MRS) and functional magnetic resonance imaging (fMRI) to study disordered brain chemistry (GABAergic systems) and function, building upon our previous scientific work. We have focused on the critical role of emotion and distress in psychosis, functions very relevant for social functioning and overall outcome.
Understanding the brain systems that underlie psychosis is key to designing better interventions, both pharmacologic and psycho-social (such as CBT). Recruitment for this study has been underway since the fall of 2013, and we will continue enrolling participants through the summer of 2015.
If you’re interested in participating, or want to learn more about this study, please go to our study page.
Extending our clinical work with CBT, we are designing innovative implementations with an eye to improving CBT. We have completed work on a CBT manual, and are in the process of setting up initial trials with this manual. We will be conducting work to examine mechanisms of CBT, using fMRI brain scans and electrophysiology. An improved understanding of how CBT changes the brain can help improve CBT itself. For example, cognitive training paradigms may be used to enhance the effect of CBT, and fMRI studies may be used to determine how to design those enhancement strategies. We are also developing a paradigm to use exercise to enhance the effect of CBT. Making CBT more effective means that we will have more therapeutic tools that can stop the progression of psychosis.
First Episode Treatment Network
A critical part of any research activity is gaining the power of numbers by collaborating within research networks. We are in discussions to join a first episode treatment network coordinated by Dr. John Kane of Zucker Hillside Hospital in New York. This network will provide access to innovative new pharmacotherapies for qualifying patients.
Brain imaging studies of augmentation agents
We have initiated work to study specific neurotransmitter systems implicated in schizophrenia, such as GABA, the major inhibitory neurotransmitter in the brain. In clinical practice, this neurotransmitter is affected by several classes of drugs, including benzodiazepines (lorazepam, clonazepam, diazepam). Benzodiazepines have been effectively used as augmentation agents with antipsychotics, although side effects (sedation, memory loss) and abuse potential limit their use. A better drug to target GABA is needed, and one of the steps to developing such an agent is understanding how existing drugs affect GABA systems. We are now planning treatment studies to track down the mechanisms of the beneficial effects of GABAergic drugs (and others). This improved understanding of drug mechanisms should lead to the design of better drugs, with stronger therapeutic effects and fewer side effects.
Brain mapping social function with fMRI and ERP
One of the notable functions disrupted by psychosis is the ability to socialize and effectively maintain interpersonal relationships. Known broadly as social cognition, this important domain consists of many specific components, such as perceiving eye gaze. We have shown how gaze perception is disrupted in psychosis, and planned work will use fMRI to extend studies we have begun with event-related potentials (ERP). Identifying the disrupted components of social cognition will allow the design of behavioral and pharmacologic interventions that can target this part of psychosis. To date, there are no known treatments that specifically improve social cognition in psychosis, so identifying the disrupted components of social cognition will allow the design of behavioral and pharmacologic interventions that can target this part of psychosis.
Metabolism, cardiovascular health, and antipsychotic treatment
One of the unfortunate side effects of antipsychotics is a higher risk of metabolic syndrome (‘pre-diabetes’) and diabetes. The relationship between metabolism, antipsychotic treatment, and psychosis also reveals important clues about psychosis itself, such as links between inflammation and cardiovascular health. In collaboration with Dr. Vicki Ellingrod in the School of Pharmacy, we are carrying out a study of metabolic factors that influence cardiovascular health, exploring the potential beneficial role of folic acid supplementation for individuals on antipsychotic therapy. This current work focuses on individuals with long-standing schizophrenia, but future work will also focus on some of the genetic risk factors and possible preventive strategies for individuals with early psychosis who require antipsychotic therapy.