Innovating Care and Discovery |Early Identification

Identification of the Neural Circuitry of Persistent Negative Symptoms in First Episode Schizophrenia

Effective treatments for persistent negative symptoms in patients who have experienced their first episode of schizophrenia are a major unmet need, and the neural circuitry of these symptoms remains unknown. This study, led by Dr. Aristotle Voineskos, aims to identify neural circuitry biomarkers of persistent negative symptoms in this patient group. Identifying biomarkers can provide essential neurobiological information to accelerate intervention efforts for negative symptoms early in the disease progression. As a secondary aim, the study will use neuroimaging data to predict longitudinal persistent negative symptom status; this innovative approach would rapidly identify patients earlier who might suffer from these symptoms and will serve as an important step in providing a more personalized approach to care, thus optimizing the outcomes for patients suffering from these debilitating symptoms.

Uncovering Pathways to Psychosis to Enhance Early Identification and Prevention Efforts: Characterizing Psychosis Risk After Antecedent Disorders

Psychotic disorders such as schizophrenia cause major impairments throughout life. The sooner effective treatment is initiated after the onset of this illness, the better the outcome and prognosis for the patient. However, timely treatment is only possible if the psychosis is recognized at the beginning. Affiliate Scientist Dr. Wanda Tempelaar is working with the Institute for Clinical Evaluative Sciences (ICES) to use routinely collected health data to investigate trajectories of psychiatric disorders. ICES is a publicly funded, not-for-profit research institute and its research is highly regarded in Canada and abroad. ICES data is widely used by governments, hospitals, planners and practitioners to make decisions about care delivery and to develop policy. This study aims to investigate trajectories of mental health disorders preceding the onset of psychotic disorder in youth. Findings from this work will significantly advance our understanding of risk trajectories, to improve early detection and intervention.

Using Electrophysiological Indices of Auditory Processing to Estimate Psychosis Risk in Clinical High Risk Youth 

Efforts to identify people at high risk of developing schizophrenia, and prevent its disability, are crucial. High-risk patients, who have milder forms of schizophrenia symptoms, have 400 times the normal risk of developing the disorder. Yet, the majority of high-risk patients will not develop the illness. Providing them with unnecessary psychiatric treatments may expose them to unnecessary risks — including side effects and stigma — and is costly and time-consuming. To target treatment to those most in need, new tests are needed to predict which patients are most likely to develop schizophrenia and/or have long-term persistent symptoms. This study, led by Dr. Michael Kiang, and funded by the Miner’s Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness, aims to examine the use of electroencephalographic (EEG or “brainwave”) biomarkers to further predict individual disease trajectories within high-risk groups, narrowing down the relatively large group of people considered at high risk for developing psychosis.

To date, this study has detected a number of brainwave abnormalities in patients at high risk for psychosis, and has found that the severity of some of these abnormalities predicts future disability versus recovery. The results could lay the groundwork for a practical prognostic test, enabling researchers to target treatment trials toward those at greatest risk of developing psychosis. Data collection is ongoing and has resulted in several peer-reviewed journal publications so far.

Synaptic density as a trait marker of early psychosis: a longitudinal [18F]SynVesT-1 positron emission tomography (PET) study

Building on the work that was initiated through funding from the Slaight Centre Seed award, Dr. Omair Husain and Dr. Christin Schifani have been successfully funded by the Canadian Institutes of Health Research to conduct a large brain imaging study examining the change over time in brain synaptic density in individuals experiencing a first episode of psychosis, and youth at clinical high risk for psychosis. This is the first study of its kind in this population, and provides a unique opportunity to identify a novel biomarker of disease pathology and illness progression at the earliest stages of psychosis that could serve as a target for novel treatment innovation to alter the onset and course of psychosis for youth.

Is increased blood brain barrier (BBB) permeability a feature of first episode psychosis?

This study is looking for young adults between the ages of 17-35 who have experienced symptoms of psychosis for less than 2 years and have been taking antipsychotic medications for less than 6 weeks. This study is looking to understand if there is a change in blood brain barrier or BBB permeability when people experience symptoms of psychosis. The BBB is the protective layer that lines the inner surfaces of the blood vessels inside your brain and is what allows oxygen and nutrients to move from your blood into your brain. For the study you would be asked to complete 2 dynamic contract enhanced (DCE)-MRIs, which uses a gadolinium-based contrast injection. The study visits also include fasting bloodwork, physical measurements, clinical and cognitive assessments. There will be a total of three visits: screening, MRI scanning visit, and a 6 month-follow-up MRI visit. If all visits and procedures are completed, you will be compensated $210 and reimbursed for travel costs.

Characterization and Prediction of Individual Functional Outcome Trajectories in Schizophrenia Spectrum Disorders (PREDICTS)

People with schizophrenia spectrum and related psychotic disorders experience significant functional impairments, disability, and low rates of personal recovery, along with lost productivity and premature mortality. Several contributors to this disability have been identified, including a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. While these findings have helped identify broad patterns of illness and outcomes, at present it is not possible to predict with confidence a particular individual’s functional course in a manner that would enable a personalized treatment approach to improve functional outcomes and mitigate the ensuing disability they would otherwise experience.  To advanced precision care for individuals with psychotic disorders, a large cohort study funded by the CAMH Discovery Fund and led by Drs. George Foussias and Margaret Hahn, along with many scientists from the Slaight Centre, the Schizophrenia Division, and across CAMH, along with people with lived experience, has been launched this past year.  To date, over 200 youth and adult participants with psychosis have been recruited, with a target sample size of 1,000 participants that will be followed over 5 years.  The findings from this study are anticipated to identify the key early predictors of discrete trajectories of personal recovery, disability, and community functioning experienced by individuals with psychosis, and provide the foundation for the co-design and testing of personalized interventions to alter these functional trajectories and improve outcomes for people with psychosis at the earliest stage of illness.