Raising Hope - A NIMH Study

  • There's some good news for people diagnosed with schizophrenia. The National Institute on Mental Health (NIMH), with additional funding from the American Recovery and Reinvestment Act (ARRA)-commonly known as the economic stimulus plan-will shortly conduct a research project aimed at halting the disability that occurs after a first episode of schizophrenia.

    The Recovery After an Initial Schizophrenia Episode (RAISE) study will explore whether using early and aggressive treatment, targeted to the individual and integrating a variety of different therapeutic approaches, will reduce the symptoms and prevent the gradual deterioration of function that is a feature of chronic schizophrenia.

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    Although moderately effective treatments, such as antipsychotic medications and various psychosocial interventions exist, too often people with schizophrenia do not receive treatment until the disease is already well-established, with recurrent episodes of psychosis. Periods of unemployment, homelessness, and incarceration are common. Thus schizophrenia is a costly disease for individuals, their families and the community at large.


    Thomas R. Insel, M.D. is the director of NIMH and champions the research project thus: "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." He adds this benefit, "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. This study will test approaches that involve intervening immediately upon first diagnosis, systematically incorporating the range of options that are now available in a more piecemeal fashion to people with schizophrenia. These options include medications, psychosocial treatments, and rehabilitation, and teaching patients and families how to manage the disease.

    The ultimate goal is that this coordinated approach tailored to each individual and sustained over time may make lasting difference in the acceptability of treatment and overall function.

    The design of the interventions to be evaluated by RAISE will be implemented with participation from agencies and organizations that play a role in providing health care and other services to people with schizophrenia. The Substance Abuse and Mental Health Services Administration (SAMHSA), the Social Security Administration, the Centers for Medicare and Medicaid Services, the Department of Veterans Affairs, the Walter Reed Army Medical Center, and the National Institute on Drug Abuse (NIDA) will be involved along with mental health care consumers and family members, private health care providers, additional scientific experts and state and local agencies.

  • According to the NIMH press release, "Involving these stakeholders will help ensure that, if successful, this evidence-based approach can be disseminated and adopted rapidly, thus significantly speeding the transition between research findings and their use in real-world practice."

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    Psychosocial is a term that is used to describe therapy and support groups, day programs, supportive living and even volunteer work, as well as Clubhouses and drop-in centers and social activities. Rehabilitation refers to the improvement of ADL skills (activities of daily living) and long-term recovery outcomes. Options here include state offices of vocational rehabilitation that train people for work or assist them in looking for work, supported jobs where a job coach assists a person with schizophrenia in getting and keeping work, the Ticket to Work Act in the U.S. and education. Another choice is an IPRT-Intensive Psychiatric Rehabilitation Treatment-center, like the one in Hollis, Queens in New York City. Therapeutic farm communities where the residents create a product, or peer-run micro businesses such as gift shops and cafes, fall under this umbrella as well.

    As someone who received positive results from this three-pronged approach (medication, psychosocial and rehabilitation), I can vouch for the benefits of attending a day program (to get support and encouragement from therapists and peers as I worked on recovery goals), living in a residence (to transition successfully into independent living) and being sent by the Office of Vocational Rehabilitation to word processing school (I found my first job with private health benefits).

    It remains to be seen whether those individuals in the study, or most people, will experience their own lasting benefits and reduction in the negative effects of disability after participating in the research project or adopting these practices in their own lives. I sure hope RAISE does what it sets out to do.

    As always, I'd love to hear from you about this and other stories being covered here at the Connection. In the coming months, I will focus on breaking news and research in the schizophrenia field.



Published On: August 02, 2009