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Clinical High-Risk Syndromes (sometimes called prodromal syndromes) are technical terms used by mental health professionals to describe symptoms that may precede the onset of psychosis. In psychosis, people lose contact with reality and have delusions (unrealistic beliefs) or hallucinations (seeing, hearing or smelling things that are not perceived by others).

The word "prodrome" means a set of symptoms that are risk factors for - and may precede - the onset of a more serious illness. For example, high blood pressure is a prodromal risk factor for cardiovascular (heart) disease. Not everyone who has high blood pressure will develop heart disease, but reducing blood pressure reduces the risk of a heart attack. Likewise, not everyone who has a clinical high-risk syndrome will develop a psychotic illness - it depends on a lot of things, such as their family history of mental illness, how much stress they face in their lives, whether they use street drugs, and other factors. But improving the emotional health of the family appears to be one way of reducing the risk of psychotic illness.

The clinical risk phase of psychosis, which can occur any time between the ages of 13 and about 30 years, is the critical time period when individuals are showing signs of risk for developing a psychotic illness. This at-risk phase may last anywhere from a couple of days to a couple of years. During this time, individuals may experience subthreshold (mild or moderate) psychosis symptoms (such as hearing sounds others don't hear or feeling suspicious of others) for weeks or months at a time, or more severe psychosis symptoms for only a few days.

While each person's symptoms are unique, there are some common themes to look out for. Early signs and symptoms can include any of the following:

Unusual Thinking (e.g., confusion about what is real and what is imaginary, suspiciousness or paranoid thinking)

Perceptual Disturbances (e.g., hearing or seeing things that others don't hear)

Negative Symptoms (e.g., not feeling motivated to do things, difficulty identifying and expressing emotions)

Disorganized Symptoms (e.g., trouble with attention, neglect of person hygiene, clear problems with verbal communication)

Often, these symptoms go along with changes in functioning such as trouble completing schoolwork, trouble socializing or relating to others, sleep disturbances, irritability, or anxiety. People with psychosis risk syndromes often have other psychiatric disorders such as attention deficit hyperactivity disorder, depression, social anxiety disorder, or substance abuse disorders.

UPLIFT is a research study that stands for "Understanding Prodromes and Lessening Illness with Family Therapy." It is a research consortium of seven universities with funding from the National Institute of Mental Health. The purpose of the study is to determine what forms of therapy are most effective for what subgroups of people with clinical high risk syndromes, and how it helps them and their families.

The University of California, Los Angeles (UCLA) is the main organizing site; the Principal investigators are David Miklowitz, Ph.D. and Carrie Bearden, Ph.D., both of the UCLA Semel Institute for Neuroscience and Behavior. You can participate in UPLIFT at UCLA or at any of the collaborative sites in the U.S. or Canada:

    University of California, San Francisco School of Medicine
    University of California, San Diego School of Medicine
    Yale University School of Medicine
    Zucker-Hillside Hospital/Northwell Health System, Glen Oaks, New York
    Mathison Centre for Mental Health, Research & Education, University of Calgary, Canada

You must be between the ages of 13 years and 25 years old, have family members (parents, siblings, grandparents, or other guardians) who are willing to participate and attend regular treatment sessions, and meet criteria for a clinical high risk syndrome. Otherwise, see the "Am I eligible?" tab.

The first contact will be through a phone call where you and your parent(s) will be asked questions to determine whether you may be eligible for UPLIFT. You'll then be asked to attend a 2-4 hour research consenting and diagnostic interview session, which will occur by a Zoom video call or, if the pandemic restrictions have been lifted, through an in person meeting at one of our clinics. Persons under the age of 18 must be accompanied by a parent/guardian. The evaluator will meet with you and your parent(s) together for a short period to gather background information. Then, your parent(s) will step out while we conduct the bulk of the interview with you alone. At the end of the assessment we will give the results of the assessment to you and your parent. Treatment options can be discussed at this time. The interview can be done over two sessions if you're finding that one is too long. The interview will determine whether you have ever had symptoms of psychosis and, if not, if you have a clinical high risk syndrome. We will also ask whether you have had any symptoms of anxiety, depression, or substance or alcohol abuse, now or in the past. This diagnostic evaluation is done for free. The reason we interview your parent as well as you is that we need to combine information from multiple people to make sure we're getting the right diagnostic picture. That way, we can be sure to make the right treatment recommendations.

If you are eligible for the study and consent to participate, you and your family will receive one of two forms of talk therapy, determined by random assignment (a procedure like tossing a coin). All treatments are provided by licensed clinicians or clinical personnel under the direct supervision of a licensed psychologist or board-certified psychiatrist.Family-focused therapy (FFT), an 18-session therapy involving you and your parents (and siblings, if they are available).

FFT involves one-hour sessions of psychoeducation (learning about prodromal syndromes, what causes them, how they are affected by stress, and how to keep them from getting worse), communication enhancement training (practicing effective ways of speaking and listening to each other as a family), and problem-solving skills training (learning to identify and solve problems in your social, school, work, or family life). Your therapist will be well-trained and skilled in conducting the sessions.

Enhanced care (EC), an 8-session therapy also involving you and your family members, but with an opportunity for individual sessions as well. The first 3 sessions are held weekly and are for you and your family. As in FFT, you'll learn how to cope with prodromal syndromes and strategies for preventing them from getting worse. Then, you will get individual supportive therapy sessions once a month for the next 5 months.

Yes, you can get other therapies like individual or group therapy while you are in therapy with us. Keep in mind that it may be hard to balance the time commitments of this study with other treatments you are receiving.

The study requires an 18-month commitment. The first 6 months are devoted to treatment, and then at months 6, 12, and 18 you'll be asked to complete research interviews and questionnaires.

Currently, the study is being conducted by telehealth video sessions so that you will not have to leave your home. You will be asked to use a mobile app for the 6 months of treatment with questionnaires to complete that will help us measure your progress.

You will not be billed for any interviews, treatment sessions, or other tasks required by the study. You will be compensated for your time in completing research interviews.

As long as you remain in the study (up to 18 months), your therapist and research staff members will be available for providing support, information about coping strategies, or for referrals to other providers. Society may benefit from a greater understanding of what treatments help individuals with clinical high risk syndromes.

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