Psychosis, Schizoaffective Disorder, Schizophrenia, Schizophrenia Spectrum and Other Psychotic Disorders
Conditions
Brief summary
The purpose of this study is to examine state representation in individuals aged 15-45 who have been diagnosed with a psychotic illness, as well as young adults who do not have a psychiatric diagnosis. State Representation is our ability to process information about our surroundings. Participants will complete computerized tasks that measure state representation while having their brain activity measured.
Detailed description
Participants will be asked to complete two sets of appointments six months apart. During both sets of appointments, participants will be asked to complete interviews examining behaviors and symptoms of mental health conditions, self-report questionnaires, and a neurocognitive assessment. In addition, participants will complete an imaging appointment, in which they will receive simultaneous electroencephalography (EEG) and functional Magnetic Resonance Imaging (fMRI) while performing two computerized tasks. The purpose of this study is to determine how differences in information processing that support state representation in neural circuits relate to clinical heterogeneity in early psychosis. To this end, the investigators will: (a) Recruit people with early psychosis and demographically similar adults without a psychiatric illness aged 15-45 years; (b) Determine test-retest reliability of variants of the Dot Pattern Expectancy (DPX) and Bandit tasks as assessments of state representation processes; (c) Characterize behavioral performance and neurophysiology at baseline using the DPX and Bandit task variants during simultaneous EEG-fMRI along with other MRI modalities; (d) Follow patients for 6 months while they receive usual care, to delineate their clinical trajectories; (e) Repeat the behavioral and EEG-fMRI assessments after six months. The data the investigators acquire will allow us to examine the baseline relationships between clinical and experimental measures, and also to investigate how changes in clinical and experimental measures are related over a 6-month time period during a critical phase of illness. Participants in this protocol will be invited to participate in a follow on study, NCT05664594.
Interventions
None listed
Sponsors
National Institute of Mental Health (NIMH)
University of Minnesota
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
15 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* English proficiency, as determined by staff observation and participant self-report * Estimated IQ at or above 70, as estimated by the cognitive assessments Additional Inclusion Criteria for Early Psychosis Participants: * Clinical diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, psychosis NOS, bipolar disorder with psychosis, or major depressive disorder with psychosis; those aged 36-45 years old must have had with onset of psychotic symptoms within the previous 5 years * Achieved clinical stability, defined as outpatient status for at least one month prior to study participation
Exclusion criteria
* Unable or unwilling to provide informed consent * The participant is unable to demonstrate adequate decisional capacity, in the judgment of the consenting study staff member, to make a choice about participating in the research study * Participant is pregnant * Participant is illiterate * Cannot pass the CMRR Subject Safety Screen due to MRI contraindications * Presence of a major neurological disorder (psychosis participants may have an autism spectrum diagnosis) * Previous clinically significant head injury or prolonged unconsciousness, as determined by the PI/Co-Is * Meets criteria for substance or alcohol dependence within 3 months of enrollment * The presence of any major medical condition that, in the opinion of the PI/Co-Is, would impede participation in the study or would put the participant at additional risk by participating * Presence of severe alcohol or substance abuse * Has participated in significant formal cognitive training programs, as determined by the PI/Co-Is Additional
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Performance of Dot Pattern Expectancy (DPX) Task Variant | Baseline, 6 month follow up | The DPX task variant consists of a series of pattern sequences. One pattern is designated the A cue, and another the X cue, which requires one response (AX, 60-70% of trials, e.g. respond with the left button), while other sequences require a different response (AY or BX, 12-15% of trials each, or BY, 6-10% of trials, e.g. respond with the right button). Given the strong expectation that X's evokes a valid response, BX trials place demands on the fidelity (stability, memory) of the B cue state representation to overcome this tendency. Performance is assessed based on accuracy and response time. |
| Change in Performance of Bandit Task Variant | Baseline, 6 month follow up | This is a task variant that uses choice options (neutral images) that are rewarded probabilistically. The rewarded stimulus with the highest reward is changed over time. State learning associated with staying or switching stimuli too quickly (lose-switching) can be evaluated. Performance is based on accuracy, response time, and behavior of reward seeking. |
| Change in Test My Brain Neurocognitive Assessment performance: Global Cognition Z Score. | Baseline, 6 month follow up | The investigators will examine global cognition scores from the Test My Brain neurocognitive battery. Z scores range from -5 to 5, with higher score indicating increased cognitive functioning. |
| Change in EEG Variables | Baseline, 6 month follow up | Analysis will examine variables including phase synchrony, slope of the spectral power density (indexing E-I balance), and prefrontal/parietal theta as a measure of perceptual noise. |
| Change in MRI Variables | Baseline, 6 month follow up | MRI assessments will include structural MRI, Diffusion-weighted MRI, Resting State fMRI. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in symptoms and functioning as indicated by the IDI | Baseline, 6 month follow up | The Intersectional Discrimination Index is a 31-item measure assesses anticipated, day to day, and major discrimination experienced by the participant. Scores range from 0-136, with higher scores indicating greater discrimination experienced by the individual. |
| Change in symptoms and functioning as indicated by the WHODAS 2.0 Brief | Baseline, 6 month follow up | The World Health Organization Disability Assessment Schedule is a 12-item self-administered scale measuring disability and functional impairment. The WHODAS ranges in score from 12-60, with a higher score indicating increased disability. |
| Change in symptoms and functioning as indicated by the GFS/GFR | Baseline, 6 month follow up | The Global Functioning Social/Global Functioning Role scales provide a rating on a scale from 1-10 for social functioning and for role functioning, with higher scores indicating increased functioning. |
| Change in symptoms and functioning as indicated by the BPRS | Baseline, 6 month follow up | The Brief Psychiatric Rating Scale is a 24-item interview which assesses psychiatric symptoms. Scores on the BPRS rang from 24-168, with a higher score indicating increased symptom severity. |
| Change in Test My Brain Neurocognitive Assessment performance: Verbal Pair Associates Memory Z Score | Baseline, 6 month follow up | This subdomain of the TMB battery assesses verbal learning. Z scores range from -5 to 5, with higher score indicating increased functioning. |
| Change in Test My Brain Neurocognitive Assessment performance: Matrix Reasoning Z Score | Baseline, 6 month follow up | This subdomain of the TMB battery assesses reasoning skills and also provides an IQ estimate. Z scores range from -5 to 5, with higher score indicating increased functioning. |
| Change in Test My Brain Neurocognitive Assessment performance: Multiracial Emotion Identification Z Score | Baseline, 6 month follow up | This subdomain of the TMB battery is a social cognition test that assesses the ability to recognize emotions (happiness, sadness, anger, and fear). Z scores range from -5 to 5, with higher score indicating increased functioning. |
| Change in Test My Brain Neurocognitive Assessment performance: Digit Symbol Matching Z Score | Baseline, 6 month follow up | This subdomain of the TMB battery assesses processing speed. Z scores range from -5 to 5, with higher score indicating increased functioning. |
| Change in symptoms and functioning as indicated by Minnesota Symptom Severity Scale | Baseline,6 month follow up | This 29-item measure assesses symptoms in several domains such as anxiety, depression, sleep problems, somatic symptoms, and substance use. Scores range from 0 to 116, with a higher score indicating greater symptom severity. |
| Change in symptoms and functioning as indicated by the SANS/SAPS | Baseline, 6 month follow up | The Scale for Assessment of Negative Symptoms (SANS, 25 items) and Scale for Assessment of Positive Symptoms (SAPS, 34 items) assess negative and positive symptoms of schizophrenia in a standardized interview. Scores on the SANS ranges from 0-125, and the SANS ranges from 0-170, with higher scores indicating increased symptom severity. |
| Change in symptoms and functioning as indicated by the SPQ-BR | Baseline, 6 month follow up | Schizotypal Personality Questionnaire Brief Revised, a 32-item measure to assess a broad array of schizotypal symptoms and signs. The SPQ ranges from 32-160, with a higher score indicating greater schizotypy. |
| Change in symptoms and functioning as indicated by the SGI | Baseline, 6 month follow up | The Sensory Gating Inventory Brief is a 10-item measure assesses an individual's subjective ability to modulate, filter, over-include, discriminate, attend to, and tolerate sensory stimuli. The SGI ranges from 10-60, with higher score indicating increased perceptual abnormalities. |
Countries
United States
Outcome results
None listed