An Integrated Program for the Treatment of First Episode of Psychosis

NCT ID: NCT01321177

Last Updated: 2021-10-26

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

404 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-07-31

Study Completion Date

2017-07-31

Brief Summary

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The purpose of this study is to determine how services should be provided to reduce symptoms and improve life functioning for adolescents and adults who have been recently diagnosed with schizophrenia.

Detailed Description

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Schizophrenia is a major mental illness characterized by psychosis, negative symptoms (e.g., apathy, social withdrawal, anhedonia), and cognitive impairment. Depression and substance abuse commonly co-occur. These individuals have impaired functioning in the areas of work, school, parenting, self-care, independent living, interpersonal relationships, and leisure time. Among adult psychiatric disorders, schizophrenia is the most disabling, and its treatment accounts for a disproportionate share of mental health services.

This study is part of the National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) Project. The RAISE Project seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated and aggressive treatment in the earliest stages of illness. This study, the RAISE Early Treatment Program (ETP), is one of the two independent research studies that NIMH has funded to conduct the NIMH RAISE Project. ETP is being supported in whole or in part with Federal funds from the American Recovery and Reinvestment Act of 2009 and the NIMH, National Institutes of Health, Department of Health and Human Services.

The ETP study aims to compare two early treatment interventions for adolescents and adults experiencing a first episode of psychosis. The clinical centers have been randomly allocated to offer one of the two treatment programs. Both treatment interventions are designed to provide a person with treatment soon after he or she experiences the early signs of schizophrenia. Participants will be offered mental health services such as medication and psychosocial therapy. These strategies are all aimed at promoting symptom reduction and improving life functioning. Participation in this study will last between 2 and 3 years. All participants will first undergo an initial videoconference interview to confirm a diagnosis of schizophrenia, schizoaffective disorder, psychosis NOS, brief psychotic disorder, or schizophreniform disorder. Eligible participants will then be offered mental health services.

In addition to the mental health services, participants will participate in a series of research interviews. Participants will be interviewed every 3 months for the first 6 months and then every 6 months for up to 3 years. At the research visit, participants will complete an interview about their symptoms and general quality of life, complete questions about experiences with their illness, their vital signs will be measured, and a blood draw will be collected. At the initial, 12 and 24 month visits, participants will also complete a brief test that assesses skills such as memory, attention and problem solving. Participants will also have monthly telephone interviews about their illness and services that they have received.

Conditions

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Schizophrenia Schizoaffective Disorder Schizophreniform Disorder Brief Psychotic Disorder Psychotic Disorder NOS

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Integrated Treatment

Integrated program of treatments and services delivered by a coordinated team of providers.

Group Type EXPERIMENTAL

Integrated Treatment

Intervention Type BEHAVIORAL

Integrated program of treatments and services delivered by a coordinated team of providers that includes:

* education about schizophrenia and its treatment for the participants and their family members
* medication for symptoms and preventing relapse that uses a computerized decision support system
* strategies for managing the illness and building personal resilience
* help getting back to school or work using a supported employment/education model

Community Care

Standard mental health treatments and services offered at the local agency.

Group Type ACTIVE_COMPARATOR

Community Care

Intervention Type BEHAVIORAL

Standard mental health treatments and services offered at the local agency that may include :

* medication for symptoms and preventing relapse
* psychosocial therapy which may include a range of behavioral treatments and supportive services
* Case management

Interventions

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Integrated Treatment

Integrated program of treatments and services delivered by a coordinated team of providers that includes:

* education about schizophrenia and its treatment for the participants and their family members
* medication for symptoms and preventing relapse that uses a computerized decision support system
* strategies for managing the illness and building personal resilience
* help getting back to school or work using a supported employment/education model

Intervention Type BEHAVIORAL

Community Care

Standard mental health treatments and services offered at the local agency that may include :

* medication for symptoms and preventing relapse
* psychosocial therapy which may include a range of behavioral treatments and supportive services
* Case management

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Confirmed SCID DSM-IV clinical diagnosis by trained remote clinical assessor of:

* schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, psychotic disorder NOS
* Any duration of untreated psychosis
* Any ethnicity
* Ability to participate in research assessments in English
* Ability to provide fully informed consent (assent for those under age 18)

Exclusion Criteria

* Inability to understand what research participation entails or correctly answer the questions about research participation that are part of the Study Information Review and provide fully informed consent
* More than 4 months of prior cumulative treatment with antipsychotic medications
* Diagnosis of bipolar disorder, psychotic depression or substance-induced psychotic disorder
* Current psychotic disorder due to a general medical condition
* Current neurological disorders that would affect diagnosis or prognosis. These would include, but are not limited to seizure disorders, dementing or degenerative disorders, lesions or substantial congenital abnormalities. In most cases, disorders such as headache disorders would not require protocol exclusion
* Clinically significant head trauma
* Any other serious medical condition that in the opinion of the investigator would seriously impair functioning making the patient unsuitable for the trial
Minimum Eligible Age

15 Years

Maximum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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State University of New York - Downstate Medical Center

OTHER

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role collaborator

Dartmouth-Hitchcock Medical Center

OTHER

Sponsor Role collaborator

Research Foundation for Mental Hygiene, Inc.

OTHER

Sponsor Role collaborator

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

Northwell Health

OTHER

Sponsor Role lead

Responsible Party

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John Kane

Chairman, Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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John Kane, MD

Role: PRINCIPAL_INVESTIGATOR

Feinstein Institute for Medical Research

Locations

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San Fernando Mental Health Center

San Fernando, California, United States

Site Status

Santa ClaritaMental Health Center

Santa Clarita, California, United States

Site Status

Mental Health Center of Denver

Denver, Colorado, United States

Site Status

United Services Inc.

Willimantic, Connecticut, United States

Site Status

Henderson Mental Health Center

Fort Lauderdale, Florida, United States

Site Status

Life management Center of Northwest Florida

Panama City, Florida, United States

Site Status

Central Fulton Community Mental Health Center

Atlanta, Georgia, United States

Site Status

Cobb County Community Services Board

Austell, Georgia, United States

Site Status

Park Center

Fort Wayne, Indiana, United States

Site Status

Community Mental Health Center, Inc.

Lawrenceburg, Indiana, United States

Site Status

Eyerly Ball

Des Moines, Iowa, United States

Site Status

Terrebonne Mental Health Center

Houma, Louisiana, United States

Site Status

River Parish Mental Health Center

Laplace, Louisiana, United States

Site Status

Catholic Social Services of Washtenaw County (CSSW)

Ann Arbor, Michigan, United States

Site Status

Touchstone Innovare

Grand Rapids, Michigan, United States

Site Status

Clinton-Eaton-Ingham Community Mental Health Authority

Lansing, Michigan, United States

Site Status

Human Development Center

Duluth, Minnesota, United States

Site Status

North Point Health and Wellness

Minneapolis, Minnesota, United States

Site Status

Pine Belt Mental Health Clinic

Hattiesburg, Mississippi, United States

Site Status

Burrell Behavioral Health

Columbia, Missouri, United States

Site Status

UMKC School of Pharmacy

Kansas City, Missouri, United States

Site Status

Burrell Behavioral Health

Springfield, Missouri, United States

Site Status

Community Alternatives

St Louis, Missouri, United States

Site Status

Community Mental Health Center of Lancaster County

Lincoln, Nebraska, United States

Site Status

The Mental Health Center of Greater Manchester

Manchester, New Hampshire, United States

Site Status

Greater Nashua Mental Health Center @ Community Council

Nashua, New Hampshire, United States

Site Status

Saint Clare's Hospital

Denville, New Jersey, United States

Site Status

University of New Mexico Department of Psychiatry UNM Health Sciences Center

Albuquerque, New Mexico, United States

Site Status

PeaceHealth Oregon/Lane County Behavioral Health Services

Eugene, Oregon, United States

Site Status

Lehigh Valley Hospital Mental Health Clinic

Allentown, Pennsylvania, United States

Site Status

South Shore Mental Health Center

Charlestown, Rhode Island, United States

Site Status

The Providence Center

Providence, Rhode Island, United States

Site Status

Howard Center

Burlington, Vermont, United States

Site Status

Countries

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United States

References

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Mueser KT, Sussman RF, DeTore NR, Eberlin ES, McGurk SR. The impact of early intervention for first episode psychosis on cognitive functioning. Schizophr Res. 2023 Oct;260:132-139. doi: 10.1016/j.schres.2023.07.021. Epub 2023 Aug 30.

Reference Type DERIVED
PMID: 37657279 (View on PubMed)

Hong SI, Bennett D, Rosenheck RA. Gender differences in outcomes of early intervention services for first episode psychosis. Early Interv Psychiatry. 2023 Jul;17(7):715-723. doi: 10.1111/eip.13367. Epub 2023 Jan 9.

Reference Type DERIVED
PMID: 36623822 (View on PubMed)

Bornheimer LA, Cobia DJ, Li Verdugo J, Holzworth J, Smith MJ. Clinical insight and cognitive functioning as mediators in the relationships between symptoms of psychosis, depression, and suicide ideation in first-episode psychosis. J Psychiatr Res. 2022 Mar;147:85-93. doi: 10.1016/j.jpsychires.2022.01.006. Epub 2022 Jan 5.

Reference Type DERIVED
PMID: 35026597 (View on PubMed)

Bornheimer LA, Wojtalik JA, Li J, Cobia D, Smith MJ. Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition. Schizophr Res. 2021 Feb;228:298-304. doi: 10.1016/j.schres.2020.12.025. Epub 2021 Jan 23.

Reference Type DERIVED
PMID: 33493778 (View on PubMed)

Bornheimer LA, Tarrier N, Brinen AP, Li J, Dwyer M, Himle JA. Longitudinal predictors of stigma in first-episode psychosis: Mediating effects of depression. Early Interv Psychiatry. 2021 Apr;15(2):263-270. doi: 10.1111/eip.12935. Epub 2020 Feb 12.

Reference Type DERIVED
PMID: 32052566 (View on PubMed)

Robinson DG, Schooler NR, Rosenheck RA, Lin H, Sint KJ, Marcy P, Kane JM. Predictors of Hospitalization of Individuals With First-Episode Psychosis: Data From a 2-Year Follow-Up of the RAISE-ETP. Psychiatr Serv. 2019 Jul 1;70(7):569-577. doi: 10.1176/appi.ps.201800511. Epub 2019 May 14.

Reference Type DERIVED
PMID: 31084291 (View on PubMed)

Nuttall AK, Thakkar KN, Luo X, Mueser KT, Glynn SM, Achtyes ED, Kane JM. Longitudinal associations of family burden and patient quality of life in the context of first-episode schizophrenia in the RAISE-ETP study. Psychiatry Res. 2019 Jun;276:60-68. doi: 10.1016/j.psychres.2019.04.016. Epub 2019 Apr 16.

Reference Type DERIVED
PMID: 31026764 (View on PubMed)

Mueser KT, Meyer-Kalos PS, Glynn SM, Lynde DW, Robinson DG, Gingerich S, Penn DL, Cather C, Gottlieb JD, Marcy P, Wiseman JL, Potretzke S, Brunette MF, Schooler NR, Addington J, Rosenheck RA, Estroff SE, Kane JM. Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study. Schizophr Res. 2019 Feb;204:271-281. doi: 10.1016/j.schres.2018.08.015. Epub 2018 Aug 20.

Reference Type DERIVED
PMID: 30139553 (View on PubMed)

Bornheimer LA. Suicidal Ideation in First-Episode Psychosis (FEP): Examination of Symptoms of Depression and Psychosis Among Individuals in an Early Phase of Treatment. Suicide Life Threat Behav. 2019 Apr;49(2):423-431. doi: 10.1111/sltb.12440. Epub 2018 Feb 14.

Reference Type DERIVED
PMID: 29444349 (View on PubMed)

Robinson DG, Schooler NR, Correll CU, John M, Kurian BT, Marcy P, Miller AL, Pipes R, Trivedi MH, Kane JM. Psychopharmacological Treatment in the RAISE-ETP Study: Outcomes of a Manual and Computer Decision Support System Based Intervention. Am J Psychiatry. 2018 Feb 1;175(2):169-179. doi: 10.1176/appi.ajp.2017.16080919. Epub 2017 Sep 15.

Reference Type DERIVED
PMID: 28945118 (View on PubMed)

Rosenheck RA, Estroff SE, Sint K, Lin H, Mueser KT, Robinson DG, Schooler NR, Marcy P, Kane JM; RAISE-ETP Investigators. Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis. Am J Psychiatry. 2017 Sep 1;174(9):886-894. doi: 10.1176/appi.ajp.2017.16111273. Epub 2017 Apr 21.

Reference Type DERIVED
PMID: 28427286 (View on PubMed)

Kane JM, Robinson DG, Schooler NR, Mueser KT, Penn DL, Rosenheck RA, Addington J, Brunette MF, Correll CU, Estroff SE, Marcy P, Robinson J, Meyer-Kalos PS, Gottlieb JD, Glynn SM, Lynde DW, Pipes R, Kurian BT, Miller AL, Azrin ST, Goldstein AB, Severe JB, Lin H, Sint KJ, John M, Heinssen RK. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. Am J Psychiatry. 2016 Apr 1;173(4):362-72. doi: 10.1176/appi.ajp.2015.15050632. Epub 2015 Oct 20.

Reference Type DERIVED
PMID: 26481174 (View on PubMed)

Kane JM, Schooler NR, Marcy P, Correll CU, Brunette MF, Mueser KT, Rosenheck RA, Addington J, Estroff SE, Robinson J, Penn DL, Robinson DG. The RAISE early treatment program for first-episode psychosis: background, rationale, and study design. J Clin Psychiatry. 2015 Mar;76(3):240-6. doi: 10.4088/JCP.14m09289.

Reference Type DERIVED
PMID: 25830446 (View on PubMed)

Robinson DG, Schooler NR, John M, Correll CU, Marcy P, Addington J, Brunette MF, Estroff SE, Mueser KT, Penn D, Robinson J, Rosenheck RA, Severe J, Goldstein A, Azrin S, Heinssen R, Kane JM. Prescription practices in the treatment of first-episode schizophrenia spectrum disorders: data from the national RAISE-ETP study. Am J Psychiatry. 2015 Mar 1;172(3):237-48. doi: 10.1176/appi.ajp.2014.13101355. Epub 2014 Dec 4.

Reference Type DERIVED
PMID: 25727536 (View on PubMed)

Other Identifiers

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HHSN271200900019C

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

HHSN271200900019C

Identifier Type: -

Identifier Source: org_study_id