Psycho-pharmacologic treatments are among the most important services investigators have to offer to patients with mental illnesses. Although a relatively rich database is available about how psychotropic medications perform in rigorous placebo-controlled efficacy trials, much less is known about the extent to which specific medications improve outcomes in patients in natural treatment settings. The objective of this proposal is to take advantage of the research, service, and education capacities now available in the State of Connecticut, Department of Mental Health (DMH) and at Yale University School of Medicine (Yale) to advance the field of psychopharmacology into medications effectiveness research by creating a clinical mental health service research program focusing on the research theme of medication effectiveness -- the Medications Effectiveness Research Development Program (MERP). The MERP will be built primarily by recruitment of established and developing psychopharmacology mental health clinical researchers in the Yale University School of Medicine Department of Psychiatry (Yale) into the medications effectiveness services research field. The MERP is designed to strengthen an existing public academic liaison (PAL) between the State of Connecticut Department of Mental Health Research Division (DMH) and Yale by enhancing the services research component of the ongoing DMH-Yale collaboration. Senior outside consultants have been recruited to assist in the building of increased local expertise in clinical mental health services research, mental health economics, and biostatistical analysis. Pilot projects from program investigators will be solicited, reviewed, funded, and monitored by the program. Data from the pilot projects will then be used to demonstrate the promise and feasibility of studies proposed in subsequent independent grant applications. The MERP will focus on medications effectiveness questions across a broad range of research methodologies and psychopathologic targets. Proposed studies address questions of treatment effectiveness, implementation effectiveness, and medication utilization. Six approved studies are proposed in the psychopathologic areas of depression, anxiety, psychosis, and dual diagnosis of mental illness and substance abuse. Study 1 will investigate the treatment effectiveness of risperidone versus traditional neuroleptic for noncompliant patients with schizophrenia in a public sector acute inpatient unit. Study 2 will investigate the treatment effectiveness of lithium versus T3 augmentation in patients with refractory depression in a public sector outpatient clinic. Study 3 will investigate the treatment effectiveness of a specific serotonin reuptake inhibitor versus a secondary amine tricyclic in private practice patients with major depression. Study 4 will investigate the treatment effectiveness of buspirone versus benzodiazepines in generalized anxiety patients in a primary care clinic. Study 5 will investigate the implementation effectiveness of community reinforcement of disulfiram compliance in patients with alcoholism and schizophrenia in a second public sector outpatient clinic. The last study, (number 6) will investigate the implementation effectiveness of a clinician education program on adverse effects of typical neuroleptics.
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