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ARRA Investments in Schizophrenia: Comparative Effectiveness Research

Public Health Burden
Schizophrenia is a devastating mental illness. Symptoms that characterize the disorder, such as hallucinations and delusions, often derail normal academic and vocational progress and disrupt the development of social and interpersonal relationships that prepare a young person for adult roles and responsibilities. Individuals with schizophrenia are greatly dependent on family members and the limited services provided by Federal, State, and local systems of care and financing. Finally, the disorder is responsible for enormous losses in productivity and income, both for patients and caregivers.

Comparative Effectiveness Studies
Comparative effectiveness studies compare the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions. Such studies can provide information on the relative strengths and weaknesses of various medical interventions for schizophrenia and help clinicians and patients make treatment decisions. Given current knowledge of the earliest phases of schizophrenia, the best chance for altering the discouraging prognosis commonly associated with the illness may be to intervene aggressively at the first episode of psychosis, before functional abilities are lost. Preventing the disability associated with schizophrenia also has the potential to reduce the disease's impact on public systems, such as Social Security, law enforcement, state mental health services, and private organizations that serve those with mental illnesses. ARRA funds will be used for several studies of schizophrenia treatment, including the following:
  • Two contract awards bolstered by ARRA funds will develop interventions that can be tested in real-world treatment settings and be readily adopted and quickly put into practice should they prove successful, through the Recovery After an Initial Schizophrenia Episode (RAISE) Project. RAISE is designed to alter the long-term disability that can result from schizophrenia and help ensure that people with the disorder can lead productive, independent lives. The RAISE Project will examine this approach by supporting the development and testing of two complementary models for early intervention in schizophrenia. Both treatments are designed to be deployed in real-world settings and to be cost-effective. From the earliest stages of development, these interventions will incorporate features necessary for rapid dissemination into community settings, thus facilitating the transition from research to practice. Treatment models being tested in both studies focus on intervening as soon as possible after the first episode of schizophrenia. Each model integrates medication, psychosocial therapies, family involvement, rehabilitation services, and supported employment, all aimed at promoting symptom reduction and improving life functioning. One project, the RAISE Early Treatment Program, will conduct trials in community clinics across the United States.1 The other project, the RAISE Connection Program, will be conducted at community clinics in partnership with the Maryland and New York state mental health systems.2 Taken together, the results of these complementary studies will inform the most effective strategies for improving the recovery of functioning and quality of life for people affected by schizophrenia.
  • Another project will determine cost-effectiveness and long-term outcomes of a specialized multi-component intervention for individuals with psychotic disorders, such as schizophrenia. The investigators will conduct a pragmatic, randomized controlled trial comparing specialized multi-component care to treatment as usual in a clinically meaningful population of individuals who are early in the course of a psychotic disorder. Re-hospitalization rates, clinical status, functional status, and costs will serve as outcomes of the project.3

  1. N01271200900019C – Recovery After an Initial Schizophrenia Episode (RAISE) – Kane, John (NY)
  2. N01271200900020C – Recovery After an Initial Schizophrenia Episode (RAISE) – Lieberman, Jeffrey (NY)
  3. 1RC1MH088971-01 – Specialized Treatment Early in Psychosis (STEP): A Community Health Center-Based Intervention – Srihari, Vinod (CT)

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