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出境医 / 临床实验 / A Study of Antipsychotics in Individuals at Clinical High-risk for Psychosis (the SHARP-2 Study)

A Study of Antipsychotics in Individuals at Clinical High-risk for Psychosis (the SHARP-2 Study)

Study Description
Brief Summary:
The current study will improve knowledge on the effectiveness and safety of the use of antipsychotics at the prodromal phase and on factors influencing the outcome, and will eventually facilitate optimisation of individualised interventions for psychosis prevention and treatment.

Condition or disease Intervention/treatment
Clinical High-risk Other: routine clinical treatment

Detailed Description:

Help-seeking first-visit participants will be consecutively recruited. Every participant meeting the inclusion criteria will be fully informed of the study and asked to sign the written informed consent before enrolment.

Two senior nurses that will conduct the initial screenings were employed to collect all diagnostic and medication information from medical records on every follow-up visit. The four psychiatrists are qualified and well-trained and will conduct the SIPS/SOPS interview at baseline and follow-up.

The investigators will systematically record medication information. A model will be established to correlate antipsychotics with clinical and functional outcomes and demonstrate whether antipsychotics are useful and safe for preventing CHR individuals from converting to psychosis.

Based on experience from the sampling process in the SHARP-1 project, the investigators will recruit 600 participants at CHR. Considering a dropout rate of 20%, 510 cases of CHR will be followed up. According to the sample size calculation formula in superiority clinical trials of new drugs, the sample size of 600 cases is adequate for the demonstration of the effectiveness and safety of antipsychotics in CHR subjects.

Study Design
Layout table for study information
Study Type : Observational [Patient Registry]
Estimated Enrollment : 600 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 3 Years
Official Title: Real-world Effectiveness and Safety of Antipsychotics in Individuals at Clinical High-risk for Psychosis: Study Protocol for a Prospective Observational Study (SHARP-2)
Actual Study Start Date : March 29, 2019
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : December 2022
Arms and Interventions
Group/Cohort Intervention/treatment
SHARP-2
ShangHai At Risk for Psychosis-Phase 2
Other: routine clinical treatment
Participants will be informed that this is not a treatment study and it involves naturalistic follow-up without any extra intervention. They will otherwise follow the routine clinical treatment procedure.

Outcome Measures
Primary Outcome Measures :
  1. Conversion to psychosis [ Time Frame: 4 weeks ]
    It will be determined using the criteria for the Presence of Psychotic Symptoms from SIPS. Specifically, the conversion will be defined by the presence of level 6 positive symptoms (the rating "6" refers to severe and psychotic symptoms) identified as either dangerous, disorganised, or occurring at least one hour a day on average, over four days a week for at least 16 hours.

  2. Poor function [ Time Frame: 4 weeks ]
    It will be determined by GAF score. Specifically, poor function outcome is defined as the GAF score of less than 60 at the follow-up point.


Biospecimen Retention:   Samples With DNA
whole blood

Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   14 Years to 45 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Help-seeking first-visit participants will be consecutively recruited from the Shanghai Psychotherapy and Psychological Counselling Centre at the Shanghai Mental Health Centre. They will be screened for eligibility by their clinicians.
Criteria

Inclusion Criteria:

  • be aged 14 to 45-year-old
  • have had at least 6-years of primary education
  • be drug-naïve
  • be understanding the survey, be willing to enrol in the study and sign the informed consent
  • Through the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS), the participants should meet the Criteria of Prodromal Syndrome. Participants should fulfil at least one of the prodromal syndrome criteria: (1) brief intermittent psychotic syndrome, (2) attenuated positive symptom syndrome, or (3) genetic risk and deterioration syndrome

Exclusion Criteria:

  • Through the Mini-International Neuropsychiatric Interview (MINI), Axis I mental disorders such as schizophrenia, affective disorders, and anxiety spectrum disorders will be excluded
  • Acute or chronic renal failure; liver cirrhosis or active liver diseases
  • Abnormal laboratory tests results judged by the researchers to be clinically significant and considered to affect the efficacy of the test drugs or the safety of the subjects
  • Severe or unstable physical diseases, including: neurological disorders (delirium, dementia, stroke, epilepsy, migraine, etc.), congestive heart failure, angina pectoris, myocardial infarction, arrhythmia, hypertension (including untreated or uncontrolled hypertension), malignant tumours, immune compromise, and blood glucose above 12 mmol/L
  • Alcohol abuse within 30 days, or alcohol or drug dependence within 6 months before the trial
  • Pregnant or lactating women, or women in childbearing age who are positive in urine human chorionic gonadotropin test, or men and women who do not take effective contraceptive measures or plan for pregnancy within 3 months after the initiation of the trial
  • Stroke within the last month
  • Participating in any clinical trial within 30 days before the baseline
  • Other situations judged by the investigators not to be suitable for the clinical trial
Contacts and Locations

Contacts
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Contact: TianHong Zhang, Doctor 13127577024 zhang_tianhong@126.com

Locations
Layout table for location information
China
Shanghai Mental Health Center Recruiting
Shanghai, China
Contact: TianHong Zhang, Doctor    13127577024    zhang_tianhong@126.com   
Sponsors and Collaborators
Shanghai Mental Health Center
Ministry of Science and Technology of the People´s Republic of China
National Natural Science Foundation of China
Shanghai Municipal Science and Technology Commission
Shanghai Jiao Tong University School of Medicine
Investigators
Layout table for investigator information
Principal Investigator: TianHong Zhang, Doctor Shanghai Mental Health Center
Tracking Information
First Submitted Date July 4, 2019
First Posted Date July 8, 2019
Last Update Posted Date October 22, 2020
Actual Study Start Date March 29, 2019
Estimated Primary Completion Date December 2022   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: July 4, 2019)
  • Conversion to psychosis [ Time Frame: 4 weeks ]
    It will be determined using the criteria for the Presence of Psychotic Symptoms from SIPS. Specifically, the conversion will be defined by the presence of level 6 positive symptoms (the rating "6" refers to severe and psychotic symptoms) identified as either dangerous, disorganised, or occurring at least one hour a day on average, over four days a week for at least 16 hours.
  • Poor function [ Time Frame: 4 weeks ]
    It will be determined by GAF score. Specifically, poor function outcome is defined as the GAF score of less than 60 at the follow-up point.
Original Primary Outcome Measures Same as current
Change History
Current Secondary Outcome Measures Not Provided
Original Secondary Outcome Measures Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title A Study of Antipsychotics in Individuals at Clinical High-risk for Psychosis (the SHARP-2 Study)
Official Title Real-world Effectiveness and Safety of Antipsychotics in Individuals at Clinical High-risk for Psychosis: Study Protocol for a Prospective Observational Study (SHARP-2)
Brief Summary The current study will improve knowledge on the effectiveness and safety of the use of antipsychotics at the prodromal phase and on factors influencing the outcome, and will eventually facilitate optimisation of individualised interventions for psychosis prevention and treatment.
Detailed Description

Help-seeking first-visit participants will be consecutively recruited. Every participant meeting the inclusion criteria will be fully informed of the study and asked to sign the written informed consent before enrolment.

Two senior nurses that will conduct the initial screenings were employed to collect all diagnostic and medication information from medical records on every follow-up visit. The four psychiatrists are qualified and well-trained and will conduct the SIPS/SOPS interview at baseline and follow-up.

The investigators will systematically record medication information. A model will be established to correlate antipsychotics with clinical and functional outcomes and demonstrate whether antipsychotics are useful and safe for preventing CHR individuals from converting to psychosis.

Based on experience from the sampling process in the SHARP-1 project, the investigators will recruit 600 participants at CHR. Considering a dropout rate of 20%, 510 cases of CHR will be followed up. According to the sample size calculation formula in superiority clinical trials of new drugs, the sample size of 600 cases is adequate for the demonstration of the effectiveness and safety of antipsychotics in CHR subjects.

Study Type Observational [Patient Registry]
Study Design Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration 3 Years
Biospecimen Retention:   Samples With DNA
Description:
whole blood
Sampling Method Non-Probability Sample
Study Population Help-seeking first-visit participants will be consecutively recruited from the Shanghai Psychotherapy and Psychological Counselling Centre at the Shanghai Mental Health Centre. They will be screened for eligibility by their clinicians.
Condition Clinical High-risk
Intervention Other: routine clinical treatment
Participants will be informed that this is not a treatment study and it involves naturalistic follow-up without any extra intervention. They will otherwise follow the routine clinical treatment procedure.
Study Groups/Cohorts SHARP-2
ShangHai At Risk for Psychosis-Phase 2
Intervention: Other: routine clinical treatment
Publications *
  • Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rössler A, Schultze-Lutter F, Keshavan M, Wood S, Ruhrmann S, Seidman LJ, Valmaggia L, Cannon T, Velthorst E, De Haan L, Cornblatt B, Bonoldi I, Birchwood M, McGlashan T, Carpenter W, McGorry P, Klosterkötter J, McGuire P, Yung A. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry. 2013 Jan;70(1):107-20. doi: 10.1001/jamapsychiatry.2013.269. Review.
  • Nelson B, Yuen HP, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, Broussard C, Simmons M, Foley DL, Brewer WJ, Francey SM, Amminger GP, Thompson A, McGorry PD, Yung AR. Long-term follow-up of a group at ultra high risk ("prodromal") for psychosis: the PACE 400 study. JAMA Psychiatry. 2013 Aug;70(8):793-802. doi: 10.1001/jamapsychiatry.2013.1270. Erratum in: JAMA Psychiatry. 2013 Oct;70(10):1008.
  • Lindström E, Bingefors K. Patient compliance with drug therapy in schizophrenia. Economic and clinical issues. Pharmacoeconomics. 2000 Aug;18(2):106-24. Review.
  • Crumlish N, Whitty P, Clarke M, Browne S, Kamali M, Gervin M, McTigue O, Kinsella A, Waddington JL, Larkin C, O'Callaghan E. Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. Br J Psychiatry. 2009 Jan;194(1):18-24. doi: 10.1192/bjp.bp.107.048942.
  • Zhang T, Xu L, Tang Y, Cui H, Wei Y, Wang J, Tang X, Li C, Wang J. Duration of untreated prodromal symptoms in a Chinese sample at a high risk for psychosis: demographic, clinical, and outcome. Psychol Med. 2018 Jun;48(8):1274-1281. doi: 10.1017/S0033291717002707. Epub 2017 Nov 27.
  • Zhang T, Xu L, Tang Y, Cui H, Tang X, Wei Y, Wang Y, Hu Q, Qian Z, Liu X, Li C, Wang J. Relationship between duration of untreated prodromal symptoms and symptomatic and functional recovery. Eur Arch Psychiatry Clin Neurosci. 2019 Dec;269(8):871-877. doi: 10.1007/s00406-018-0917-z. Epub 2018 Jun 25.
  • Zhang T, Cui H, Wei Y, Tang Y, Xu L, Tang X, Zhu Y, Jiang L, Zhang B, Qian Z, Chow A, Liu X, Li C, Xiao Z, Wang J. Progressive decline of cognition during the conversion from prodrome to psychosis with a characteristic pattern of the theory of mind compensated by neurocognition. Schizophr Res. 2018 May;195:554-559. doi: 10.1016/j.schres.2017.08.020. Epub 2017 Aug 18.
  • Zhang T, Cui H, Tang Y, Xu L, Li H, Wei Y, Liu X, Chow A, Li C, Jiang K, Xiao Z, Wang J. Correlation of social cognition and neurocognition on psychotic outcome: a naturalistic follow-up study of subjects with attenuated psychosis syndrome. Sci Rep. 2016 Oct 10;6:35017. doi: 10.1038/srep35017.
  • Collin G, Seidman LJ, Keshavan MS, Stone WS, Qi Z, Zhang T, Tang Y, Li H, Anteraper SA, Niznikiewicz MA, McCarley RW, Shenton ME, Wang J, Whitfield-Gabrieli S. Functional connectome organization predicts conversion to psychosis in clinical high-risk youth from the SHARP program. Mol Psychiatry. 2020 Oct;25(10):2431-2440. doi: 10.1038/s41380-018-0288-x. Epub 2018 Nov 8.
  • Shakory S, Watts JJ, Hafizi S, Da Silva T, Khan S, Kiang M, Bagby RM, Chavez S, Mizrahi R. Hippocampal glutamate metabolites and glial activation in clinical high risk and first episode psychosis. Neuropsychopharmacology. 2018 Oct;43(11):2249-2255. doi: 10.1038/s41386-018-0163-0. Epub 2018 Jul 28.
  • Rauchensteiner S, Kawohl W, Ozgurdal S, Littmann E, Gudlowski Y, Witthaus H, Heinz A, Juckel G. Test-performance after cognitive training in persons at risk mental state of schizophrenia and patients with schizophrenia. Psychiatry Res. 2011 Feb 28;185(3):334-9. doi: 10.1016/j.psychres.2009.09.003. Epub 2010 May 21.
  • Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, Berger GE. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010 Feb;67(2):146-54. doi: 10.1001/archgenpsychiatry.2009.192.
  • McGorry PD, Nelson B, Markulev C, Yuen HP, Schäfer MR, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger GE, Chen EY, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, Amminger GP. Effect of ω-3 Polyunsaturated Fatty Acids in Young People at Ultrahigh Risk for Psychotic Disorders: The NEURAPRO Randomized Clinical Trial. JAMA Psychiatry. 2017 Jan 1;74(1):19-27. doi: 10.1001/jamapsychiatry.2016.2902.
  • McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, McDonald T, Blair A, Adlard S, Jackson H. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry. 2002 Oct;59(10):921-8.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Recruiting
Estimated Enrollment
 (submitted: July 4, 2019)
600
Original Estimated Enrollment Same as current
Estimated Study Completion Date December 2022
Estimated Primary Completion Date December 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria

Inclusion Criteria:

  • be aged 14 to 45-year-old
  • have had at least 6-years of primary education
  • be drug-naïve
  • be understanding the survey, be willing to enrol in the study and sign the informed consent
  • Through the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS), the participants should meet the Criteria of Prodromal Syndrome. Participants should fulfil at least one of the prodromal syndrome criteria: (1) brief intermittent psychotic syndrome, (2) attenuated positive symptom syndrome, or (3) genetic risk and deterioration syndrome

Exclusion Criteria:

  • Through the Mini-International Neuropsychiatric Interview (MINI), Axis I mental disorders such as schizophrenia, affective disorders, and anxiety spectrum disorders will be excluded
  • Acute or chronic renal failure; liver cirrhosis or active liver diseases
  • Abnormal laboratory tests results judged by the researchers to be clinically significant and considered to affect the efficacy of the test drugs or the safety of the subjects
  • Severe or unstable physical diseases, including: neurological disorders (delirium, dementia, stroke, epilepsy, migraine, etc.), congestive heart failure, angina pectoris, myocardial infarction, arrhythmia, hypertension (including untreated or uncontrolled hypertension), malignant tumours, immune compromise, and blood glucose above 12 mmol/L
  • Alcohol abuse within 30 days, or alcohol or drug dependence within 6 months before the trial
  • Pregnant or lactating women, or women in childbearing age who are positive in urine human chorionic gonadotropin test, or men and women who do not take effective contraceptive measures or plan for pregnancy within 3 months after the initiation of the trial
  • Stroke within the last month
  • Participating in any clinical trial within 30 days before the baseline
  • Other situations judged by the investigators not to be suitable for the clinical trial
Sex/Gender
Sexes Eligible for Study: All
Ages 14 Years to 45 Years   (Child, Adult)
Accepts Healthy Volunteers No
Contacts
Contact: TianHong Zhang, Doctor 13127577024 zhang_tianhong@126.com
Listed Location Countries China
Removed Location Countries  
 
Administrative Information
NCT Number NCT04010864
Other Study ID Numbers CRC2018ZD04
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement
Plan to Share IPD: Yes
Supporting Materials: Study Protocol
Supporting Materials: Statistical Analysis Plan (SAP)
Supporting Materials: Informed Consent Form (ICF)
Supporting Materials: Clinical Study Report (CSR)
Supporting Materials: Analytic Code
Responsible Party Tianhong ZHANG, Shanghai Mental Health Center
Study Sponsor Shanghai Mental Health Center
Collaborators
  • Ministry of Science and Technology of the People´s Republic of China
  • National Natural Science Foundation of China
  • Shanghai Municipal Science and Technology Commission
  • Shanghai Jiao Tong University School of Medicine
Investigators
Principal Investigator: TianHong Zhang, Doctor Shanghai Mental Health Center
PRS Account Shanghai Mental Health Center
Verification Date October 2020