Leaders of AMP Schizophrenia Describe International Collaboration to Find Biomarkers for Psychosis Risk

An international collaboration led by the National Institute of Mental Health (NIMH) will enable researchers to develop algorithms that chart the different trajectories of individuals at high risk for schizophrenia.

At a session today at APA’s Annual Meeting, leaders of the Accelerating Medicines Partnership (AMP) Schizophrenia initiative said the effort is aimed at discovering biomarkers for outcomes that may serve as targets for early intervention.

“This study, the largest of its kind, will allow us to analyze the trajectory of people at elevated risk for schizophrenia beyond the dichotomous outcomes of having psychosis or not having psychosis,” said Sarah Morris, Ph.D., chief of the Adult Psychopathology and Psychosocial Interventions Development Branch at NIMH. “AMP Schizophrenia will allow us to look at the more complex trajectories and range of outcomes that we have not had the statistical power to look at in previous studies.”

AMP Schizophrenia is a collaboration of 42 sites in the United States, Canada, Europe, Australia, and Asia specializing in the identification and treatment of people at clinical high risk (CHR) for psychosis. Also participating are the pharmaceutical industry, advocacy organizations including the APA Foundation, and individuals with lived experience of being at risk for psychosis.

The initiative, which began enrolling patients last month, is a natural evolution of the effort that began in the 1980s to identify individuals at high risk of psychosis using clinical criteria such as family history, transient psychotic symptoms, social withdrawal, and functional impairment. AMP Schizophrenia will use neuroimaging, electrophysiology, digital technologies, cognitive measures, genomic studies, and collection of blood for inflammatory and other markers to search for biological indicators of psychosis risk.

Data emerging from the study will be shared broadly with the scientific community via the NIMH Data Archive. A separate AMP Schizophrenia website provides information to potential participants and psychiatrists who want to refer a patient.

In comments to Psychiatric News before the meeting, Morris explained that one limitation of using CHR criteria is that while some 30% of CHR individuals do go on to develop psychosis, many do not. “We know from prior research that people at risk with subthreshold symptoms have a variety of outcomes—some persist in having those subthreshold symptoms for years and years, others have a variety of other psychiatric outcomes including severe depression or anxiety, and a subset appear to remit,” Morris said. “Having a study this large will allow us to look in some detail at those different trajectories and outcomes.”

Also speaking at the Saturday session were Scott Woods, M.D., Ph.D., and Patrick McGorry, M.D., leaders of the two large networks of CHR clinics that together make up the 42 participating sites. Woods is a professor of psychiatry at Yale University and director of the PRIME Clinic at Yale. McGorry is director of the Center for Youth Mental Health at the University of Melbourne and executive director of Orygen.

Additionally, Rene Khan, M.D., Ph.D., chair of psychiatry at Mt. Sinai Icahn School of Medicine, described how data will be collected, analyzed, and shared across the participating stakeholders.

Morris emphasized data sharing as a distinctive feature of the AMP Schizophrenia initiative. “In contrast to other studies in which the investigator holds onto data and maybe shares it after publishing, data from AMP Schizophrenia will be shared on an iterative basis,” she said. Industry participants and investigators who have an approved data use agreement with the NIMH data archive will be able to access emerging knowledge about biomarkers—such as changes detected in MRI images—that may indicate a heightened level of risk and a target for intervention.

“We believe this will be an enormous scientific resource that will advance the search for early treatments to prevent psychosis and other outcomes associated with clinical high risk,” she said. ■