Columbia Leads National Effort To Develop Early Intervention For Schizophrenia

Main Category: Schizophrenia
Article Date: 23 Jul 2009 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

Columbia University Medical Center's Jeffrey A. Lieberman, M.D., a renowned expert in the field of schizophrenia, has been selected by the National Institute of Mental Health (NIMH) of the National Institutes of Health as principal investigator of a nationwide effort to develop an optimal early intervention strategy for treating people experiencing a first episode of the psychotic symptoms of schizophrenia.

Research has shown that early treatment can alter the course of schizophrenia and related psychotic disorders by dramatically slowing progression; reducing disability, mortality, and the expense of care; and increasing recovery. The Recovery After Initial Schizophrenic Episode (RAISE) study, funded at $9.9 million for two years, has the potential to be extended to six years and a total of $21.3 million if certain milestones are met.

"This award will enable researchers to demonstrate how a strategically timed intervention at the onset of symptoms can prevent the debilitating effects of one of humankind's most devastating and costly mental disorders," says Dr. Lieberman, the Lawrence E. Kolb Professor and chairman, Department of Psychiatry, Columbia University College of Physicians and Surgeons; director, New York State Psychiatric Institute; and director, Lieber Center for Schizophrenia Research. "This is a unique and historic opportunity to bring, more rapidly than we could have imagined, research and clinical efforts to bear on the question of how to reduce the burden to patient, family and society of this devastating disease."

Dr. Lieberman will lead a team of researchers from Columbia University Medical Center, the University of Maryland; University of North Carolina, UCLA, Dartmouth College and Harvard University.

Lisa B. Dixon, M.D., MPH, professor of psychiatry, University of Maryland School of Medicine; associate director of research for the Mental Illness Research, Education and Clinical Center; and director of the Division of Health Services Research at the VA Capitol Health Care Network, is co-principal investigator of RAISE.

RAISE Study to Develop & Test an Intervention That Limits Disability & Fosters Functional Recovery, While Answers to Fundamental Research Questions in Schizophrenia are Still Emerging

The goal of RAISE is to develop an evidence-based strategic intervention for early psychosis that can be facilitated both in community-based and public mental health-settings, and in private clinical practice settings. Since patient dropout and poor continuation in treatment is a major problem for schizophrenia clinicians, the intervention will encourage patients' engagement and adherence to treatment.

Drs. Lieberman, Dixon and their research team will begin by testing and refining the battery of assessments that will be used with patients who have experienced first episode psychosis (FEP) at two different FEP clinics, located at the University of North Carolina and the University of California, Davis, and then by testing the assessment model in four community-based sites, two in New York and two in Maryland.

Next, a total of 330 participants will be randomly assigned to one of two conditions in a total of eight real world clinical sites in Maryland and New York. Those in the experimental condition will receive coordinated treatment provided by a team that will include a clinical case manager, psychiatrist, nurse, employment/education specialist, skills training specialist and a team leader. Culturally appropriate, evidence-based interventions will be tailored to each patient's individual needs, with the goal of maximizing patient engagement and compliance. Individuals in the comparison group will receive treatment services managed by a clinical case manager who will link patients to appropriate community services and other resources for support and rehabilitation services. The case manager will work to engage the patient and their family in the treatment process to encourage patient retention.

"New Yorkers can be proud that this intensive effort to forestall the disability associated with schizophrenia will be led by researchers in New York State," says Michael F. Hogan, Ph.D., Commissioner of the New York State Office of Mental Health. "New approaches to the treatment of schizophrenia will be tested, emphasizing aggressive interventions as early as possible. These new approaches are aimed at helping people and their families to live with the illness and successfully transition to adult life. The Office of Mental Health intends to use the findings of these projects to help transform the care for all New Yorkers with serious mental illness."

Schizophrenia: Often Considered the Most Serious, Intractable Mental Illness

Schizophrenia affects just over one percent of the adult population. The disease often strikes in the college or early adult years, and although many experience a substantial recovery, many others experience substantial and lifelong disability. People with schizophrenia are over-represented on disability rolls, and among the homeless and imprisoned. Their unemployment rate is more than 70 percent, and the lifetime suicide rate for people with the disease is over ten percent. People with schizophrenia occupy approximately 25 percent of the nation's hospital beds (Wallis & Willwerth, 1992).

Source:
Elizabeth Streich
Columbia University Medical Center