The proposed Advanced Center for Interventions and Services Research (ACISR) focuses on community-based research in middle-aged and elderly people with schizophrenia and other chronic psychotic disorders. We will refer to our ACISR as the Center for Community-based Research in Older People with Psychoses (CCROPP). Schizophrenia is one of the most disabling and expensive illnesses, moreover, the total direct cost of schizophrenia in older people is higher than that in other age groups. The number of older adults with psychoses will more than double during next three decades. The biopsychosocial differences between older and younger cohorts of psychotic patients result in major differences in pharmacologic and psychosocial treatment considerations as well as in healthcare service utilization. Our work over the past decade has served to characterize this population, and to optimize pharmacotherapy while developing new psychosocial interventions. We are proud of our record of peer-reviewed publications, community outreach, federal and non-federal grants, a growing pool of junior and senior investigators working in this area, and unique and successful training programs. A number of our findings have had a significant impact on the clinical practice and research in the area of study. We believe that our Center has become a national and international resource for studies of this largely neglected patient population. The goal of the proposed Center is to provide a research infrastructure to promote investigations that improve real-world practice, i.e., provision of evidence-based and clinically useful treatments for the target population. Our primary community partner will be San Diego County's Adult Mental Health Services (AMHS). Additional community partners will include VA San Diego Healthcare System, community-based psychiatrists, homeless shelters, and collaborators from other parts of the country. We will focus on reducing psychopathology (primary deficits, depressive symptoms with suicidality, and functional impairment), reducing physical comorbidity (age-associated and iatrogenic), optimizing health behaviors (mainly substance use and medication adherence), and minimizing healthcare disparities. One major advance in our work as we transition to an ACISR will be a markedly increased involvement and partnership with the community stakeholders (patients, caregivers, care providers, payers, and other critical parties to patient care). Through our Research Partners Council, this partnership will guide and shape our research agenda and activities. We are confident that our work will not only advance scientific knowledge of intervention and services research, but will also have a major impact on the care of people with schizophrenia and other chronic psychotic disorders in the community.
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