John Kane, MD, chair of psychiatry at The Zucker Hillside Hospital
People with schizophrenia have long received an inconsistent mix of treatments depending on where they lived and what doctors they saw. Now, the federal government has announced an innovative study to test the impact of the best available treatments and whether the interventions will reduce future episodes of schizophrenia and help young people get their brains and lives back on track.
The study, called RAISE, is a contract funded by the National Institute of Mental Health, the National Institutes of Health and the American Recovery and Reinvestment Act (ARRA). The government will fund $40 million over six years -- of which about half is earmarked for scientists at The Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research. The project will involve two independent teams of researchers, one being led by Zucker Hillside/Feinstein scientists and another at Columbia University’s New York State Psychiatric Institute.
The interventions include the latest pharmacological and psychosocial treatments; the study design includes doctors, patients, families and scientists who will weigh in on the interventions to identify what works and what doesn’t. Once the intervention package is complete, scientists will train doctors and other health professionals throughout the country and then test the treatments in small towns and big cities around the nation where one in every 100 young adults and their families are handed the devastating diagnosis. This brain illness can cause hallucinations, delusions and life-disrupting changes in thought, mood and behavior.
Studies have shown that people with schizophrenia generally do not get appropriate treatments early enough in the course of the disease and this may lead to a more disabling form of the illness. Symptoms generally appear in late adolescence or early adulthood, and can disrupt the normal course of life and derail even the smartest minds.
Traditionally, patients have been given an inconsistent variety of treatments and studies show that most people never make it back to where they were before the symptoms hit. No one really knows how early, consistent, state-of-the-art treatments will affect the course of this illness, and this federal initiative is the first attempt to figure it out. The teams will be led by John Kane, MD, chairman of psychiatry at Zucker Hillside Hospital in Glen Oaks, NY, and Jeffrey Lieberman, MD, of Columbia University. “This is novel because there has never been an attempt to study the impact of carefully integrated modern pharmacologic and psychosocial treatments in first-episode patients,” he said. “This project will give us strategies that may change the course of illness for patients early in the disease process. We have some promising approaches that need to be combined and then tested on individuals in many different kinds of settings.
“We have a sense of what treatments work, but these interventions haven’t been tested in an integrated approach. This study is uniquely designed to answer the question of how best to treat people in the early stages of schizophrenia,” added Dr. Kane, internationally known for his work in the treatment of schizophrenia patients.
Once the interventions are selected and people trained to deliver them in a consistent fashion, 200 newly-diagnosed patients will be identified and enrolled in the study. The scientists will follow the patients over time to see whether their symptoms improve and if their social and vocational functioning get better with the selected interventions. The group will be tested against patients participating in the study and receiving standard psychiatric care in community clinics around the country.
“Can we do a better job helping patients with a more comprehensive treatment package? We definitely think so,” said Dr. Kane. “We hope this study will not only help us to change the course and outcome of schizophrenia, but also to change the way that people think about this brain disease. We hope the study will demonstrate that schizophrenia can be effectively treated and managed so that individuals who experience its onset can have a high likelihood of recovering and doing many of the things that we all take for granted: going to school, working, having hobbies, friends and intimate relationships. We’re very excited about this opportunity.”
“This new initiative will help us determine whether intervention that is started early, incorporates diverse treatment and rehabilitation approaches, and is sustained over time, can make it possible for more people with schizophrenia to return successfully to work and school,” said NIMH Director Thomas R. Insel, M.D. “Moreover, the interventions being tested will be designed from the outset to be readily adopted in real-world health care settings and quickly put into practice.”
RAISE is a model example of how money from the Recovery Act can accelerate science related to public health problems and potentially benefit those citizens most in need.
For more information on the study: http://www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml.
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