(provided by candidate): This revised application outlines an integrated training and research program for a NIMH K01 Mentored Research Scientist Development Award. My long-term career goal is to develop a program of research focused on medication effectiveness in individuals with serious mental illnesses (SMI) that includes investigating the process and outcomes of medication prescription in typical clinical practice settings, and applying this knowledge to the design of interventions to improve medication prescription decisions. My immediate career goal is to understand the prescription of complex, multi-drug regimens ('polypharmacy') in schizophrenia, focusing specifically on combination antipsychotic regimens in this application. Both clinician-related ('supply-side') and patient and family-related ('demand-side') factors, which are equally important and influential forces affecting medication management decisions will be considered. To achieve these goals, I will complete didactic coursework and mentored training activities concurrently with research projects that focus on prescription decision-making, anti-psychotic polypharmacy, and survey methods, as well as the development of interventions to improve prescription decisions in schizophrenia. These activities will be conducted under the guidance of several faculty members from across the country with expertise in mental health services research, psychopharmacology, and both cognitive and clinical psychology. A research plan of four projects is proposed. The first study will use Veterans Administration administrative encounter data to examine the prevalence and correlates of prescription of multiple antipsychotic medications in schizophrenia. This data will permit the evaluation of prescribing patterns across a range of inpatient and outpatient facilities covering a vast geographic area. The second and third studies will be conducted in conjunction with two funded NIMH R01 grants. One project will evaluate the modifiable clinician characteristics/behaviors that influence prescription decisions regarding combined antipsychotic regimens in a nation-wide sample of psychiatrists. The new third research project will examine the willingness of psychiatrists to adopt evidence-based treatments for schizophrenia and their preferences for various formats for educational interventions. The fourth study expands the evaluation of prescription decision-making in schizophrenia by focusing on the roles of both the patient and the family in this process. Understanding the patient, clinician, and treatment setting factors that are correlated with antipsychotic polypharmacy, while also uncovering aspects of the cognitive processes involved in prescription decision-making that may be modifiable, will inform the subsequent development of an R01 application aimed at improving the process of prescription decision-making for persons with schizophrenia.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01MH066009-04
Application #
7092573
Study Section
Special Emphasis Panel (ZMH1-SRV-C (05))
Program Officer
Oliver, Karen Anderson
Project Start
2003-04-01
Project End
2008-03-31
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
4
Fiscal Year
2006
Total Cost
$141,111
Indirect Cost
Name
University of Maryland Baltimore
Department
Psychiatry
Type
Schools of Medicine
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201
Brown, Clayton H; Medoff, Deborah; Dickerson, Faith B et al. (2015) Factors influencing implementation of smoking cessation treatment within community mental health centers. J Dual Diagn 11:145-50
Kreyenbuhl, Julie; Leith, Jaclyn; Medoff, Deborah R et al. (2011) A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness. Psychiatry Res 188:109-14
Kreyenbuhl, Julie; Dixon, Lisa B; McCarthy, John F et al. (2010) Does adherence to medications for type 2 diabetes differ between individuals with vs without schizophrenia? Schizophr Bull 36:428-35
Brown, Clayton; Leith, Jaclyn; Dickerson, Faith et al. (2010) Predictors of mortality in patients with serious mental illness and co-occurring type 2 diabetes. Psychiatry Res 177:250-4
Himelhoch, Seth; Leith, Jaclyn; Goldberg, Richard et al. (2009) Care and management of cardiovascular risk factors among individuals with schizophrenia and type 2 diabetes who smoke. Gen Hosp Psychiatry 31:30-2
Kreyenbuhl, Julie; Nossel, Ilana R; Dixon, Lisa B (2009) Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 35:696-703
Kreyenbuhl, Julie; Medoff, Deborah R; Seliger, Stephen L et al. (2008) Use of medications to reduce cardiovascular risk among individuals with psychotic disorders and Type 2 diabetes. Schizophr Res 101:256-65
Kreyenbuhl, Julie A; Valenstein, Marcia; McCarthy, John F et al. (2007) Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns. Psychiatr Serv 58:489-95
Kreyenbuhl, Julie; Marcus, Steven C; West, Joyce C et al. (2007) Adding or switching antipsychotic medications in treatment-refractory schizophrenia. Psychiatr Serv 58:983-90
Kreyenbuhl, Julie; Dickerson, Faith B; Medoff, Deborah R et al. (2006) Extent and management of cardiovascular risk factors in patients with type 2 diabetes and serious mental illness. J Nerv Ment Dis 194:404-10

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