Real-World Outcomes in Schizophrenia Are Focus of Two New NIMH Grants

Results can show best method of determining if treatments help patients live independently

January 4, 2008 • Science Update

Two new NIMH grants are aimed at determining the most accurate methods of measuring how well community-dwelling people with schizophrenia are faring. Results of the project are meant to provide scientists who conduct future research on the effectiveness of treatments with tools that will reflect the truest possible picture of daily-life outcomes.

The purpose of the study is not to provide or compare treatments or to interfere with treatments community clinicians have prescribed. The goal is to identify which existing measurement methods provide the most accurate assessment of participants’ skills and of their actual application of those skills — how well they function — in daily-life situations. Another goal is to determine who, in the participants’ everyday lives, are the most accurate informants of the participants’ function in the real world; for example, family, friends, or residential-center staff.

Phillip Harvey, Ph.D., of Emory University, and Thomas Patterson, Ph.D., of the University of California, San Diego, received the grants. The study will continue for five years and is meant to include 200 community-dwelling people with schizophrenia, each of whom will participate for three months.

Twice during each person’s enrollment, several designated informants will fill out a questionnaire about factors that reflect the participant’s ability to function in daily life; for example, the ability to pay the right fare to get on the right bus to get to the intended destination. In addition, the patients will report on their own functioning and perform several different assessments of their everyday living skills and cognitive abilities, such as judgment and decision making.

The research is being undertaken because current measurement tools may not accurately capture real-world outcomes. While neuropsychological tests reveal the impaired thinking characteristic of schizophrenia, they are not direct measures of the actual ability to function in real-life tasks.

When people with schizophrenia are asked to report on their functioning, the reports they provide tend to differ from those of people who know them. The researchers hypothesize that designated informants can provide realistic information about participants’ abilities to navigate such tasks. One of the researchers’ goals is to understand how to develop more user-friendly methods for assessing and reporting functional ability, both for people with schizophrenia and their informants.

Scientists have attempted to correlate results from currently used neurocognitive tests, functional tests, and daily-life rating scales, but have questioned the validity of the correlations. Being able to accurately establish such correlations could help scientists who conduct one or more of these kinds of tests to predict the results of the others. Establishing such correlations between the different types of tests, including daily-life rating, also is among the researchers’ goals.

The results of the research will add important information for scientists conducting future clinical trials of treatments for schizophrenia. It will help them better assess which ones are most effective for helping people to live independently and for improving their function in social and employment settings.

For information about participating in the study in Atlanta or San Diego, contact:

Atlanta – Philip D. Harvey, Ph.D.
Philip.harvey@emory.edu

San Diego – Thomas L. Patterson, Ph.D.
tpatterson@ucsd.edu