Intro to RM

Question 1

Why conduct resaerch on (and for) UHR groups? (4)

Answer 1

• We can develop new interventions which minimise risk of transition if we understanding why some people are UHR.
• Use clinical resournces more efficienlty if we can predict who is more likely to develop psychosis- treat the ones who are higher
• Optimse psychosis prevention interventions - If we understand why some UHR people respond to a certain treatment when others don’t
• By studying people at UHR for psychosis, we can explain the neurocognitive basis of vulnerability without the confounding effects of the illness and antipsychotic medication.

Question 2

Why conduct resaerch on (and for) FIP groups? (4)

Answer 2

• Develop new interventions aimed at minimising risk of relapse if we understand why some people with FEP relapse
• Use clinical resources more efficiently by targeting those in greatest need (more likely to relapse).
• If we understand why some people with FEP respond to treatment we can optimise interventions aimed at preventing relapse.
• By studying people with FEP, we can explain the neurocognitive basis of the illness while minimising the confounding effects of prolonged exposure to the illness and antipsychotic medication.

Question 3

What are main challanges for conducting resaech in FEP groups? (6)

Answer 3

1. Defnitions vary across different research studies making it harder to compare and summerise their results (e.g. FEP, relapse)
2. How to define inclusion/exclusion criteria. Tricky because you can be exlucing almost everyone and then what’s the point of the study but if you include too much there might be too many confounders/heterogenity = impossible to generalise (catch 22)
3. Recruitment and retention
   - Hard to have large sample with patient groups
   - Longitudional studies have high drop out rates
   - Some people are more prone to drop put (e.g. more severly ill, from a specific demographic, with some comorbid personality disorders) skewing the data
4. Ethical issues
   - can’t deny effective treatment (e.g. in RCTs) so many data is skewed by presence of other treatments alongside the investigated one OR by medication
5. Clinical Heterogeneity in psychosis, there are not identical patients
6. Poor Ecological Validity
   - Many studies have it becasue they are measuing snip bits of someone’s life–> addresses by technological advancements in reseach allowing monitoring of many factors on daily bases

Question 4

What is a the best study design to study both UHR & FEP?

Answer 4

Longitudional design, to investigate who of URH will transiton into psychosis and they will be early detected FEP
+ it allows within group comparison minimising the effects of confounders and biases.

Question 5

What are the main objectives in FEP research?

Answer 5

1. Identification of diagnostic, prognostic biomarkers (for predicting prognosis), predictive biomarkers (for predicting response to a given treatment) & mnitoring biomarkers (for monitoring illness progression)

Question 6

G x E interaction

Answer 6

Genotype creates a vulnerability for the environmental risk factors

Question 7

G x E correlation

Answer 7

Genotype encourages exposure to environmental risk factors

Question 8

What are the mian trends in research? (6)

Answer 8

1. Big data (patient records, meta-(mega)-analysis
2. Deep and continuous clinical phenotyping via digital technologies
3. Multimodal data integration
4. Individual differences (machine learning)
5. PPI (patient and public involvment)
6. Studies must have strong translational implications (not just sig results)

Question 9

Barriers of implementing reseach findings into everyday clinical practice

Answer 9

1. Studies tend to invetigate ‘extremes’ comparing healthy groups with most ‘stereotypical’ / ‘severe patients’ which is not applicable to all people with the disorder
2. Studies are often underpowered which limits they generalisability / applicability to different cohort groups
3. Studies tend to focus on effects that are
   statistically significant rather than clinically meaningful.
4. Most studies still report results at group
   level, whereas clinicians have to make clinical decisions about individual patients.