Treatment of schizophrenia requires long-term interventions that address the range of problems that the illness generates. Continuous receipt of antipsychotic medication is the bedrock on which all other interventions for schizophrenia rest and lack of adherence to a consistent medication regimen characterizes many patients over the long-term. The potential benefits of long acting medication that does not require daily self administration has only been available with first generation antipsychotics. In the United States, these medications have generally been reserved for patients who have demonstrated histories of non-compliance and repeated relapse. There is now a long acting form of one of the second-generation ('atypical') antipsychotics - risperidone microspheres. The availability of a medication that does not share either the side effect burden or the stigma associated with old long acting medications represents a major development in the treatment of schizophrenia. Evaluating the impact of the first available long-acting second-generation is therefore timely, innovative, and of considerable public health significance. With such a formative development for our field, it will be particularly important for clinicians and patients alike to acquire information on relapse prevention that is independent of pharmaceutical support in a manner comparable to prior relapse prevention studies of first generation antipsychotic medications. This eight site collaborative R01 proposes to investigate in an effectiveness, """"""""modern-day"""""""" relapse prevention design, whether a long acting second generation medication offers advantages compared to oral second-generation medication. Three hundred four consenting subjects will be randomized to physician's choice oral medication or long acting risperidone, treated for up to two and a half years, and evaluated by masked assessors on measures of psychopathology. Data to be collected will also include time to relapse, level of functioning, service utilization, and medication tolerability. All patients will receive a brief psychoeducational intervention designed to enhance treatment adherence. Even relatively modest delays in relapse and improvement of long term functioning potentially resulting from a long acting second-generation medication can translate into substantial public health benefits.
|Buckley, Peter F; Schooler, Nina R; Goff, Donald C et al. (2015) Comparison of SGA oral medications and a long-acting injectable SGA: the PROACTIVE study. Schizophr Bull 41:449-59|
|Daviss, W Burleson; Perel, James M; Brent, David A et al. (2006) Acute antidepressant response and plasma levels of bupropion and metabolites in a pediatric-aged sample: an exploratory study. Ther Drug Monit 28:190-8|
|Daviss, W Burleson; Perel, James M; Rudolph, George R et al. (2005) Steady-state pharmacokinetics of bupropion SR in juvenile patients. J Am Acad Child Adolesc Psychiatry 44:349-57|
|Axelson, David A; Perel, James M; Birmaher, Boris et al. (2005) Platelet serotonin reuptake inhibition and response to SSRIs in depressed adolescents. Am J Psychiatry 162:802-4|
|Birmaher, Boris; Kennah, Adam; Brent, David et al. (2002) Is bipolar disorder specifically associated with panic disorder in youths? J Clin Psychiatry 63:414-9|
|Axelson, David A; Perel, James M; Birmaher, Boris et al. (2002) Sertraline pharmacokinetics and dynamics in adolescents. J Am Acad Child Adolesc Psychiatry 41:1037-44|
|Brent, David A; Birmaher, Boris (2002) Clinical practice. Adolescent depression. N Engl J Med 347:667-71|