Program of Research
Program of Research Goals
The long-term goals for our program of research include establishing and growing an early psychosis research and service clinic designed to increase the scientific understanding of the origins of psychosis. Additionally, this research clinic includes studying and improving prediction of and interventions for psychosis in young people. In scientist-practitioner fashion, we attempt to achieve these goals in the context of providing effective and efficient services to youth and families in Hawaii who are either at risk for or have already been diagnosed with the disorder.
Prodromal Psychosis Research
Our primary line of research involves the understanding and predicting of the “prodrome” (the time immediately preceding psychotic symptom onset and associated with attenuated psychotic symptoms). This work offers the potential for accurate and clinically useful prediction of psychosis. We have been awarded a two-year NARSAD Young Investigator Award to prospectively study the prodrome. This research employs short-term prospective methodology, assessing youth for prodromal signs of psychosis (as well as potentially related diagnostic and neurocognitive factors) and re-evaluating the youth for the presence of psychosis after one year. Our lab has undergone a training workshop presented by the Prime Prodromal Clinic at Yale University regarding the semi-structured interview central to the research protocol. Additionally, we continue building collaborative relationships with the State of Hawaii’s Child and Adolescent Mental Health Division (CAMHD) to help facilitate this research. Related to the prodromal project, we have conducted several research projects examining schizotypal risk factors. One manuscript provided some evidence to suggest that cannabis use does not appear to be a risk factor for schizotypal symptoms in many cases. The other work suggested that schizotypal traits do not significantly differ across ethnic groups represented in Hawaii. Additionally, we are currently pursuing the description and evaluation of schizotypal qualities among youth in the general population.
The goal of our prodromal projects is to establish the ability to accurately identify the prodrome among youth in Hawaii before overt psychotic symptom onset. The long term goal of this line of work is to predict psychosis with a high degree of reliability and accuracy to understand the development of psychosis, as well as to justify early psychosocial intervention. We hope that these projects can inform the understanding and prediction of psychosis, and be used to help individuals at risk.
Clinical Services Research
Given that no prior program exists to study or serve youth with schizophrenia-spectrum disorders, we have begun to develop and investigate services addressing the specific needs of this population. To establish the justification for this type of research, we have documented that youth in Hawaii with schizophrenia-spectrum disorders have more mental health care needs and require more costly services than other youth registered in the Department of Health. We have also procured funding from CAMHD to support the assessment and treatment of youth with schizophrenia-spectrum disorders. Through this contract, my students and I have provided diagnostic and neurocognitive assessment, as well as intensive individual and family therapy to youth with schizophrenia-spectrum disorders. This work not only helps the individuals with whom we work, but also provides valuable research opportunities contributing to the understanding of this type of psychopathology.
From a scientist-practitioner perspective, we systematically examine components effective in treatment for these youth. We continue to document this process to create a manualized and testable intervention protocol. Given the rarity of schizophrenia-spectrum disorders in youth, we have relied on single-subject methodology thus far to test our interventions empirically. Along with several graduate students and a fellow faculty member, we recently documented the success of a treatment protocol for one of our clients using a single-subject design.
In addition to investigating treatment of the youth directly, we have also begun a project investigating the effects of a multifamily group for caregivers of youth with schizophrenia-spectrum disorders. We hope that a psychosocial program emphasizing education about psychosis, problem-solving skills, and peer support will result in meaningful improvement for both youth and caregivers. With continued State support, we anticipate future research and training grants working with youth with schizophrenia-spectrum disorders.
Premorbid Psychosis Research
Another line of our research examines childhood signs and predictors of adult schizophrenia using longitudinal data involving individuals at high-risk for psychosis. The bulk of this research has focused on neurological dysfunction evident in childhood prior to symptom onset as studied through a high-genetic-risk, prospective design. Our research has uncovered statistically significant links between abnormalities evident in childhood such as neuromotor dysfunction, left-side preference, and ocular alignment deficits, and the future development of schizophrenia-spectrum disorders. We have also documented theory of mind and social deficits among youth who eventually develop schizophrenia-spectrum disorders. From a theoretical perspective, this research contributes to the understanding of the neurodevelopmental origins of schizophrenia, providing evidence that neurological disruption precedes the onset of psychotic symptoms. From a clinical-research perspective, this work strives to increase the abilit to identify children at risk for developing schizophrenia and may provide opportunities for intervention prior to the onset of the disorder.