The goal of this RSA project is to allow the candidate to continue his studies on the course of schizophrenia and related psychiatric disorders. At this stage, these efforts focus on developing an empirically-based model of the processes leading to improvement in these disorders. Given the considerable evidence that many factors are involved in the course of these disorders, such a model is necessary to provide a basis for understanding, for more specific treatment interventions, and for focused hypothesis-testing research. In order to achieve this goal, a study will be carried out involving the systematic assessment of four groups of subjects: a group of patients with an extended history of schizophrenia who will be treated with the medication clozapine; leaders and members of patient consumer groups; patients who have been discharged from psychiatric hospitalization and have already been followed in a two-year follow-along study of their course; and patients discharged in the past from state hospitals and already involved in an informal study in which videotape records have been kept documenting their adaptation to community living. These four groups present a unique opportunity to study people with schizophrenia and related mental disorders who have improved or are likely to improve during the course of the project. Such a study has never been possible previously. Subjects will be interviewed with semi-structured instruments and rated on standard scales to assess their levels of symptomatology and social functioning, changes in these, and the patterns and sequences in these changes over time. Patient diagnostic, psychiatric history, and demographic data will also be collected and subjects' treatment and environmental contexts and efforts on their own behalf will also be recorded. These data will be analyzed with qualitative and quantitative methods to suggest pathways to improvement that are found and to suggest key factors in treatments, the environment, and in patients' own efforts that have been important in achieving these paths. Persons who improve will be compared with those who have not to suggest factors and longitudinal sequences that may account for these differences. Operational definitions for phases described in previous research will be completed and preliminary hypothesis-testing will be carried out. The data generated from this project will provide a range of information on a heterogeneous group of patients who improve to suggest the nature of the processes involved in improvement and approaches to more focused treatment.
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