Schizophrenia News: December 2013

  • I reported on the RAISE trial program (Recovery After Initial Schizophrenia Episode) at least five years ago when the National Institute of Mental Health first publicly reported it would fund the project.


    To refresh your memory: the RAISE study was geared to treat individuals quickly after an initial first episode with relevant educational and vocational assistance to halt as soon as possible the often-seen decline in life prospects for young people who exhibit symptoms.


    The thinking is that if you could halt the symptoms before they become entrenched (before the person starts to believe his delusions and paranoid thoughts are real) you can alter the trajectory of the disability.

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    The hope with the RAISE project is that it halts the force of the symptoms quickly enough that the disability is stopped in its tracks permanently.


    The RAISE study has been going on nationwide and with a set of 34 pilot sites.  223 people have been through the RAISE project.  The New York site has so far

    seen positive results and the results will be publicly announced in a few months.


    Robert Heinssen, a schizophrenia expert who launched the RAISE study confirmed that "the duration of untreated psychosis" or DUP influences the outcome because the longer it is, the more likely you're going to have an unfavorable outcome.


    Only about 60 existing clinics focus on early psychosis intervention, according to research, and only about a third focus on the prodrome stage.  This is the time when individuals first start to have false beliefs but before they start to think the delusions are real.


    Too often these individuals don't get treated until it's too late and their symptoms have developed into full-blown schizophrenia.


    RAISE intervenes as soon as possible by providing at-risk individuals with medication at a much lower dose than is standard for those in the later stages of the illness, along with job and education assistance and family psychoeducation.


    The patients in the RAISE study are assisted in setting goals with the aid of elements of treatment that are relevant to that person's ambitions.  The treatment occurs at one center where the individuals see the psychiatrist, therapist and social worker.


    The focus is on getting the study participants into the most developmentally appropriate jobs and school programs possible.  They are not shunted into sheltered workshops where they assemble pens or do sewing.


    The RAISE program includes the patient at the center of the decision-making. 


    My first SharePost in January will detail this person-centered approach to treatment.  For too long, doctors in their white coats prescribed pills and pushed treatment options on those in their care with little regard for the wants and needs and hopes and dreams of the patients.


    As a result, patients get discouraged and might give up all hope of having a full and robust life of their own choosing.


    Dr. Thomas Insel, the long-time director of NIMH hopes that eventually schizophrenia can become a preventable and manageable disease like heart disease.  Instead of treating schizophrenia like a chronic disease, we need to understand how to predict risk like what happened in cardiology.


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    Although not subjected to peer review yet, initial RAISE findings show marked improvements over time in employment and school participation, significantly improved vocational and social functioning, significant reductions in symptoms, and elevated rates of remission.


    The trick is getting Medicaid and other insurances to reimburse the treatment team for non-traditional services like employment support and case management.


    I will report back in here at HealthCentral when the results of the RAISE project are publicly announced.


    Stay tuned in January for the best development in person-centered treatment.


Published On: December 29, 2013