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Long-Term Course of Schizophrenia  1% prevalence of schizophrenia  1/3 of all mental health care spending in the U.S. on schizophrenia treatment  Indirect.

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Presentation on theme: "Long-Term Course of Schizophrenia  1% prevalence of schizophrenia  1/3 of all mental health care spending in the U.S. on schizophrenia treatment  Indirect."— Presentation transcript:

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2 Long-Term Course of Schizophrenia  1% prevalence of schizophrenia  1/3 of all mental health care spending in the U.S. on schizophrenia treatment  Indirect costs of schizophrenia high: loss of work, time and money spent by caregivers, law enforcement costs, etc.  World Health Organization rated schizophrenia 2nd most burdensome disease in world (15%), after cardiovascular disease (18%)

3 The Problem of First Episode Psychosis  Poor recognition  Longer duration of untreated psychosis related to worse outcomes  High rates of medication non-adherence  High rates of dropout from treatment

4 The NIMH RAISE Project  The National Institute of Mental Health Recovery After an Initial Schizophrenia Episode (RAISE) Project will test whether early, aggressive, and pre-emptive intervention can slow or halt clinical and functional deterioration in schizophrenia  RAISE research objectives: – Design and test effective interventions for early phase schizophrenia – Engineer rapid adoption and implementation of effective treatment packages by engaging “end users” at the start of intervention development – Assess clinical, functional, and economic outcomes – Generate information relevant to key stakeholders, including health care policy makers

5 The NIMH RAISE Project  NIMH awarded separate contracts to two independent research teams:  The Early Treatment Program at the Feinstein Institute for Medical Research in Manhasset, NY  The Connection Program at the Research Foundation for Mental Hygiene at Columbia University in New York, NY  The Early Treatment Program has been funded in whole or in part with Federal funds from the American Recovery and Reinvestment Act of 2009 and the NIMH/NIH/HHS under Contract No. HHSN C

6 Study Design RAISE Early Treatment Program Community Care All services at your center decided by best clinical practice NAVIGATE An experimental package of services

7 Early Treatment Program Sites

8 RAISE ETP Study Methods  Groups were assigned randomly  18 Navigate sites  17 Community Care sites  The study will compare the two groups  The study will go on for almost 4 years  People who join the study will be treated and assessed for at least 2 years  All participants have the same assessments  Diagnosis and outcome assessment by clinical raters will use live video connection  Diagnostic results and laboratory assessments will be provided to clinicians at all sites

9 RAISE ETP Study Participants  Sample size: 400  10 – 20 at each site  Age  One of these diagnoses is in the differential  schizophreniform disorder  schizophrenia  schizoaffective disorder  psychotic disorder NOS  brief psychotic disorder  Less than four months of lifetime treatment with antipsychotic medications

10 RAISE ETP Study Outcomes  Primary outcome measure: Quality of Life  Primary hypothesis  NAVIGATE intervention will improve Quality of Life significantly more than Community Care  Other measured outcomes  Service utilization  Cost  Consumer perception  Prevention of relapse  Recovery

11 NAVIGATE Services  Pharmacological Treatment  COMPASS- A decision support system for prescribers  Family Education Program (FEP)  Supported Employment and Education (SEE)  Individual Resiliency Training (IRT )

12 Pharmacological Treatment  General Principles:  Recommendations should be based upon data; avoid expert hunches about treatment  Preference given to medications with data from studies with the relevant patient groups  Consider the use of long-acting formulations of antipsychotics for maintenance treatment for all subjects  COMPASS incorporates these principles and provides an ongoing record of treatment and clinical response

13 Family Education Program (FEP)  Provide family (including client) with education about psychosis, coping strategies, skills or communicating and solving problems  Goals  Shore up relationships for the long haul  Change the trajectory of the illness by supporting resumption of role functioning and social pursuits  Reduce stress and burden in family members

14 Supported Employment and Education (SEE)  Helps clients get back on track with work or school  The goal of SEE is to help people develop and maintain personally meaningful goals related to their careers, their education, and their employment  SEE services are individualized for each person based on their preferences, goals, and values  SEE services are provided based on the person’s choice to pursue employment or education, or both

15 Individual Resiliency Training  Assists clients in learning about psychosis, processing experience, developing relapse plan, increasing resiliency, learning specific strategies and skills to achieve own personal goals; also provides case management  IRT AIMs to promote recovery  From an initial episode of psychosis via identifying client strengths.  Enhancing illness self management skills

16 Summary of RAISE ETP  A novel Clinical Trial Model  Client's consent does not involve randomization  Treatment provided openly mirrors clinical reality  Valid assessment by centralized clinical raters using live video connection  Long term treatment – at least two years  Multi-dimensional treatment incorporating known elements  Team based  Shared decision making

17 RAISE ETP Study Contacts  PeaceHealth/LaneCounty Mental Health Eugene, OR  Project Director – Carla Gerber  Research Assistant – Linda Gonzales  Contact information  Telephone 

18 Who can participate in the study?  Age 16 – 40  Clinical diagnosis includes possibility of  Schizophrenia  Schizophreniform disorder  Schizo-affective disorder  Psychosis NOS  No more than 120 days of anti-psychotic medication  Taken not prescribed

19 Family Introduction to the NAVIGATE Program  The NAVIGATE program is designed to help a person who has experienced a psychotic episode, and his/her relatives and supporters, learn the skills and information needed to help the person get back on his/her feet, and work towards having a rich and full life.  The NAVIGATE program involves a number of different interventions, including medication, individual resiliency training (IRT), help getting back to work or school (Supported Employment and Education or SEE), and a family support/education program to increase the chances of recovery from psychosis.  These interventions have been shown to be effective in helping people get on with their lives after they have experienced a psychotic episode. There is hope for recovery.  Participants will learn strategies that will them support the person in NAVIGATE to pursue his/her goals and get on with his/her life.  The person in NAVIGATE will be working with a team to help him/her with his/her goals including a doctor, program director, a clinician for counseling and resiliency training, and an expert on work and school issues. He/she will learn coping strategies that will help him/her better manage his/her situation and reach his/her goals.

20 INTRODUCTION TO JUST THE FACTS SESSIONS  We believe that recovery chances are increased if everyone in the family—  the person in NAVIAGATE and the key supporters of the person with a first  episode of psychosis-- learns about the disorder and what can be done to improve  the situation. The “Just the Facts” educational handouts review eight basic topic  areas critical to first episode psychosis:  · Facts about Psychosis.  · Facts about Medication.  · Facts about Coping with Stress.  · Facts about Developing Resiliency.  · Relapse Prevention Planning.  · Developing Collaboration with Mental Health Professionals.  · Effective Communication.  · Learn tips for addressing substance use if that is an issue in your family.  A Relative’s Guide to Supporting Recovery from Psychosis.  In addition, there is an optional handout on substance use and psychosis.

21 INTRODUCTION TO JUST THE FACTS SESSIONS  · Each topic area will typically be discussed with the family clinician in one or two  sessions. When you review the handouts with your family clinician, you will discuss  each topic area and have an opportunity to ask questions and voice your concerns.  You will:  · Review and discuss the symptoms of psychosis.  · Learn how the stress-vulnerability model can help you understand the  biological and environmental factors associated with psychosis and how to  reduce vulnerability.  · Learn facts about medications used to treat psychosis including the  advantages and disadvantages and the side effects associated with them.  NAVIGATE Family Manual – Just the Facts Family Handouts Page 82  · Develop strategies to help support the relative in NAVIGATE taking  medication regularly.  · Identify areas of stress and strategies to cope more effectively with those  stressors.  · Develop a plan to cope more effectively with stress.  · Learn how developing resiliency can help all move forward to support the  relative in NAVIGATE’s recovery.  · Identify early warning signs of relapse.  · Prepare for possible flare-ups of symptoms.  · Learn how to work closely with the relative in NAVIGATE’s treatment team.  · Understand confidentiality laws.  · Sharpen up communication.  · Learn the benefits of keeping family conflict low to help support recovery.  · Recognize the importance of everyone in the family continuing to build his or  her own life.


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