William Hargreaves - US grants

As one of four sites in the NIMH Treatment Strategies in Schizophrenia Cooperative Agreement Program, the purpose of this study is to investigate the efficacy of three drug maintenance strategies and their relationship to two psychosocial management strategies in the treatment of schizophrenic patients over two years beginning just after an acute episode. The study examines the effects of three antipsychotic drug treatments: continuous low dose (20% of standard dose); discrete targeted early intervention with placebo maintenance; and continuous standard dose. Each will be studied in combination with either supportive family management consisting of one educational workshop and monthly multiple-family meetings, or applied family management which supplements the supportive program with one year of in-home psychoeducational family treatment. Subjcts will be schizophrenic outpatients either living with or in regular contact with their family of origin, although patients will be identified for study during a period of symptom exacerbation associated with a hospitalization.

DESCRIPTION: (Adapted from Applicant's Abstract): This study examines the cost-effectiveness of the 6 outpatient treatments for schizophrenia implemented in the ongoing NIMH "Treatment Strategies in Schizophrenia" (TSS) cooperative study. The TSS study is a 5-site, 8-Year collaborative clinical trial which examines 3 antipsychotic medication maintenance strategies (standard, low, and intermittent dose) in combination with 2 psychosocial family interventions (applied behavioral and supportive ) in a 3x2 factorial design. Earlier studies have demonstrated separately the effectiveness of dose reduction and family interventions, but the TSS study is the first to examine the interactive effects of medication and family treatments. The TSS study will involve approximately 370 patients with research diagnoses of schizophrenia, schizoaffective disorder, or schizophreniform disorder who are in ongoing contact with their family of origin. The proposed cost-effectiveness study capitalizes on the unique opportunity to compare the relative cost-effectiveness of 6 well specified, carefully implemented community treatments for schizophrenia in a well-defined patient population at 5 clinical sites. The study will enumerate the societal costs of schizophrenic illness, compare the cost-effectiveness of the treatments using a variety of effectiveness measures, and compare the different types of costs incurred by each treatment group.

This is a request for an ADAMHA Research Scientist Award. The aims are (1) To examine organizational models of services at the community level and identify their operational differences; to synthesize the evidence on the the cost effectiveness of these models; and to identify key research questions and approaches; (2) To improve measures of service processes and outcomes; (3) To explore innovative data analytic techniques applicable to services research; (4) To examine the cost effectiveness of services for the severely mentally ill through controlled services trials, including (a) an assertive continuous team model compared to a paraprofessional "community companion" model and a professional clinic-based model, (b) the California capitated "Integrated Service Agency" model compared to usual services and to services in a "County Interagency Demonstration" site, (c) six treatment combinations for schizophrenics and their families, (d) additional studies focused on self-help programs, dual-diagnosis programs, and programs using atypical neuroleptics. Additional professional growth objectives are proposed.