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September 26, 2020
Early detection has always been the watchword in the treatment of medical conditions. A multidisciplinary team of researchers led by Dost Öngür, MD, PhD, chief of the Center of Excellence in Psychotic Disorders at McLean Hospital, aims to extend that to the diagnosis and treatment of psychosis.
Fueled by a grant from the National Institutes of Health, the Laboratory for Early Psychosis (LEAP) Center plans to use state-of-the-art analysis tools to comb through insurance claims and clinical data in a search for clues to what might trigger a first psychotic episode and what might be used to successfully treat it.
Psychosis is a set of disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. It is not an illness but a syndrome that includes delusions and hallucinations. Many factors can contribute to its emergence, including genetics, early life trauma, or a head injury.
First episodes usually occur in adolescence or early adulthood, with approximately 100,000 young people in the United States experiencing psychosis for the first time each year.
The LEAP Center brings Öngür together with John Hsu, MD, MBA, director of the Program for Clinical Economics and Policy Analysis at the Mongan Institute for Health Policy at Massachusetts General Hospital, and Miguel Hernán, MD, DrPH, the Kolokotrones Professor of Biostatistics and Epidemiology at the Harvard T.H. Chan School of Public Health.
The center “will leverage existing longitudinal data and use recently developed analytical tools to try to predict how psychosis might develop and what treatment might work,” Öngür explained. “There’s an unmet need because existing treatments are usually only partially effective and associated with significant side effects.”
“Early intervention is crucial, as in the treatment of any disease, because a patient who has been experiencing symptoms without successful treatment faces poorer outcomes,” he added.
Clinical data will include things like symptoms, functioning in the community, quality of life, measures of attitude and trust, and details of treatment. The information will be provided by the patient, family members, and clinicians.
“Each person presents differently and has a different course,” he said. “We will try to develop a 3D picture.”
Among the clinical data points to be examined will be substance use, particularly marijuana, which poses certain medical risks, just like alcohol and cigarettes do. Cannabis contains chemicals called endocannabinoids that interact with receptors involved in regulating brain activity.
“In teenagers—and, in particular, in the middle-teenage years—those who are smoking marijuana daily are at about a threefold higher risk of developing schizophrenia down the road,” he said. “We’re talking about pot smoking that seems to be modifying the brain and then years later actually leading to a diagnosis of schizophrenia.
There’s a risk window, and how much you smoke in that risk window seems to determine how high your risk is going to be.”
Thanks to significant philanthropic support, McLean has established the Support, Treatment, and Resilience (STAR) Program, an outpatient service providing treatment for teens and young adults ages 14-25 who are at risk for psychotic illnesses.
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