Psychoses are among the common and serious psychiatric disorders. With greater longevity, we can expect a progressive increase in the number of older psychotic patients. Antipsychotic or neuroleptic drugs are frequently prescribed for the treatment of psychotic disorders. Yet, in contrast to the large amount of literature on younger adults, there is a dearth of controlled, comprehensive, longitudinal, prospective studies of psychosis and antipsychotics in middle-aged and elderly patients. The main goals of our CRC are to provide infrastructure support to facilitate research on late-life psychosis and antipsychotics, to test hypotheses and generate new ones, and to train young scientists. Since the inception of the CRC in September 1992, we have set up the administrative, clinical, and biostatistics/data management infrastructure for research on late-life psychosis and antipsychotics. We have recruited, evaluated and followed the requisite numbers of patients and normal comparison subjects. We have been responsive to the comments of the previous study section as well as our Scientific Advisory Board. Our work to date has already produced some exciting results-e.g., clinical, neuropsychological, and brain imaging similarities as well as differences between early-onset schizophrenia (with onset before age 45) and late- onset schizophrenia (with onset after age 45). These and other findings have relevance for improving our understanding of psychosis and aging. We have published the CRC-related work in peer-reviewed journals, and generated new R01-type grant support. We are also proud of our record of training quality scientists, including women and ethnic minority candidates. We plan to continue following our current cohort of subjects, and will add 350 new subjects. We will expand our pool of chronic stable outpatients to include schizophrenia patients at two extremes of outcome: chronically institutionalized patients, and subjects with schizophrenia in remission. We will also include patients with other psychoses such as delusional disorder. The four overarching themes of the CRC are: age of onset of schizophrenia, different types of late-onset psychoses, studies of course and outcome, and psychopharmacologic research. The CRC will have seven Cores. (1) Administrative Core for facilitating the proper conductance of research and training in the CRC. (2) Biostatistics/Data Management Core for services, consultation and training in experimental methodology, statistics and data management. (3) Clinical Neuropsychiatry Core for recruitment, diagnosis, psychiatric and medical assessment and follow-up. (4) Neuropsychology Core for a comprehensive neuropsychological assessment. (5) Psychophysiology Core for evaluation of specific psychophysiologic measures. (6) Brain Imaging Core for MRI analysis. (7) Psychosocial Core for evaluating support environment, quality of life, and health-care services utilization. We have a team of experienced, as well as young, dedicated researchers with a commitment to the proposed science. We will pay special attention to the studies of women and minorities. We strongly believe that our CRC will continue to be a national resource for investigations into psychosis and antipsychotics in late life.
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