Nina Schooler - Academia.edu (original) (raw)

Papers by Nina Schooler

The Journal of clinical psychiatry, 2003

Reducing the risk of relapse and maintaining symptom control are core goals in the long-term trea... more Reducing the risk of relapse and maintaining symptom control are core goals in the long-term treatment of patients with schizophrenia or schizoaffective disorder because symptom control can allow patients and clinicians to focus on functional improvement. The atypical antipsychotic agents have gained widespread acceptance in this setting because they are at least as effective as the conventional antipsychotic agents, may offer an advantage in relapse prevention, and offer safety advantages, primarily a reduced liability for movement disorders. However, there are differences among the atypical agents that may affect both clinician choice and patient adherence to long-term therapy. Ziprasidone has shown long-term antipsychotic efficacy in comparisons with haloperidol, olanzapine, and risperidone, as well as efficacy in patients switched from another antipsychotic agent. This review examines symptom efficacy data for ziprasidone in long-term trials that lasted between 28 and 52 weeks. ...

The Journal of clinical psychiatry, 1993

A review of the literature concerning the use of oral and depot antipsychotic medication has high... more A review of the literature concerning the use of oral and depot antipsychotic medication has high-lighted some important considerations in the treatment of chronic schizophrenic patients. All patients not treated with any form of antipsychotic drug will relapse within 3 years. These relapses will be more clinically significant and will occur at greater frequency than in patients who receive medication on a regular basis. Careful consideration should be given to each patient when choosing between oral or depot medication and inpatient or outpatient therapy. In addition, the clinician should consider the dosage schedule of each medication and balance this against the probability of extrapyramidal side effects and noncompliance. One option for the prevention of relapse without an increase in adverse side effects is the administration of depot haloperidol. For all therapeutic options, medication should be given on a regular basis, since intermittent dosing strategies do not work, and ps...

JAMA Psychiatry, 2020

IMPORTANCE Long-acting injectable antipsychotics (LAIs) can potentially reduce hospitalization ri... more IMPORTANCE Long-acting injectable antipsychotics (LAIs) can potentially reduce hospitalization risk by enhancing medication adherence but are rarely considered for early-phase schizophrenia treatment. OBJECTIVE To determine whether encouraging use of a LAI compared with usual care delays the time to first hospitalization with patients with early-phase illness. DESIGN, SETTING, AND PARTICIPANTS The Prevention of Relapse in Schizophrenia (PRELAPSE) trial was cluster randomized with a follow-up duration of 2 years. The study began in December 2014, was completed in March 2019, and was conducted in 39 mental health centers in 19 US states. Site randomization assigned 19 clinics to encourage treatment with long-acting aripiprazole monohydrate (aripiprazole once monthly [AOM] condition) and 20 to provide treatment as usual (clinician's choice [CC] condition). Participant eligibility criteria included (1) schizophrenia diagnosis confirmed by a structured clinical interview, (2) fewer than 5 years of lifetime antipsychotic use, and (3) age 18 to 35 years. The AOM sites identified 576 potentially eligible participants, of whom 234 (40.6%) enrolled; CC sites identified 685 potentially eligible participants, of whom 255 (37.2%) enrolled. INTERVENTIONS There were no restrictions on treatment at CC sites (including using LAIs) or at AOM sites with the exception that aripiprazole monohydrate had to be prescribed within US Food and Drug Administration-approved guidelines. MAIN OUTCOMES AND MEASURES The primary outcome was time to first psychiatric hospitalization based on participant interviews every 2 months, the service use resource form administered every 4 months, and other sources (eg, health records) as available. Potential events were adjudicated by an independent committee masked to treatment assignment. RESULTS The 489 participants (368 men [75.3%]) had a mean (SD) age of 25.2 (4.2) years and 225 (46.0%) had 1 year or less lifetime antipsychotic use. Fifty-two AOM (22%) and 91 CC participants (36%) had at least 1 hospitalization. The mean survival time until first hospitalization was 613.7 days (95% CI, 582.3-645.1 days) for AOM participants and 530.6 days (95% CI, 497.3-563.9 days) for CC participants. For time to first hospitalization, the hazard ratio was 0.56 (95% CI, 0.34-0.92; P = .02), favoring AOM. Survival probabilities were 0.73 (95% CI, 0.65-0.83) for AOM participants and 0.58 (95% CI, 0.50-0.67) for CC participants. The number needed to treat to prevent 1 additional hospitalization was 7 participants treated with AOM compared with CC. CONCLUSIONS AND RELEVANCE Long-acting injectable antipsychotic use by patients with early-phase schizophrenia can significantly delay time to hospitalization, a personally and economically important outcome. Clinicians should more broadly consider LAI treatment for patients with early-phase illness.

Schizophrenia Bulletin, 2018

Background: Korean Neuropsychiatric Association changed the Korean term for schizophrenia from 's... more Background: Korean Neuropsychiatric Association changed the Korean term for schizophrenia from 'split-mind disorder' to 'attunement disorder' in 2012, to dispel the stigma associated with name, and to promote early detection and treatment. Information on the internet affects the public awareness and attitude toward schizophrenia. The main purpose of this study was to investigate the correlation between renaming schizophrenia and the pattern of mental health services utilization by big data analysis of internet (newspaper articles and internet searches) in Korea. Methods: From January 2016 to September 2017, newspaper articles on "attunement disorder" and "split-mind disorder" available on the internet were classified as related with negative images like crime and helpful or positive in dispelling the stigma. The relationship between the number of antistigma newspaper articles and newspaper articles of schizophrenia containing both positive and negative images was examined. In addition, using Naver, a major internet search engine in Korea, we investigated the total number of internet searches of both old and new name of schizophrenia by gender differences. Finally, the frequency of the visits of mental health services of patients with schizophrenia was measured using the Korean Healthcare Bigdata Hub (http://opendata.hira.or.kr/home.do#none) for 14 months and the correlation between the frequency of the visits and the above big data was examined. The data were analyzed using the SPSS/WIN 24.0. Pearson correlation coefficients were used to analyze correlations. Results: The amounts of newspaper articles containing anti-stigma of schizophrenia were correlated with the amounts of newspaper articles containing negative images like crime of the new name (attunement disorder) of schizophrenia (r=0.528, p<0.01), which was greater than the amounts of newspaper articles containing the old name (split-mind disorder) of schizophrenia (r=0.300, p<0.01). We also found that a strong positive correlation between the number of articles about "attunement disorder" and search frequency about the term on the internet. In addition, the search frequency was more highly related to the number of articles containing negative images of the illness (e.g., related crimes, r = 0.910, p<0.01) than that of articles providing positive aspects of the illness (e.g., dispelling stigma, r = 0.423, p<0.01). There was no significant correlation between the number of schizophrenia-related newspaper articles in previous month and the visits of mental health services of patients with schizophrenia in next month. There were no gender differences in internet searches. The correlation between the internet search frequency for "attunement disorder" in the previous month and the visits of the mental health services of patients with schizophrenia (r = 0.185, p>0.05) in next month was larger than the correlation of "split-mind disorder" searches with mental health services utilization (r = 0.082, p>0.05). Discussion: "Attunement disorder" rather than "split-mind disorder" was appeared more frequently in newspaper articles of the anti-stigma characteristics. "Attunement disorder" seems to be more useful for antistigma campaign. Renaming schizophrenia didn't seem to affect the visiting frequency of mental health services. There was statistical limitation which was originated from the lack of numbers of patient's information. It was because Korean Bigdata Hub provided patients information just for 14 months as monthly data. Also, it should be considered that the time period, the kinds of mental disorders and the search engine we investigated were limited. Future research needs to overcome these limitations.

Schizophrenia research, Jan 20, 2018

The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Tre... more The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared NAVIGATE to usual Community Care in a cluster randomized design involving 34 sites and 404 patients. This article describes the approach to training and implementing the NAVIGATE program at the 17 sites (including 134 practitioners) randomized to provide it, and to evaluating the fidelity of service delivery to the NAVIGATE model. Fidelity was evaluated to five different components of the program, all of which were standardized in manuals in advance of implementation. The components included four interventions (Individualized Resiliency Training, Family Education Program, Supported Employment and Education, Personalized Medication Management) and the overall organization (staffing and structure) of the NAVIGATE team. Most of the sites demonstrated acceptable or higher levels of fidelity in their implementation of the four interventions and...

American Journal of Psychiatry, 2017

is a Shareholder in MedAvante, Inc. and the Vanguard Research Group. Dr. John and Mr. Pipes have ... more is a Shareholder in MedAvante, Inc. and the Vanguard Research Group. Dr. John and Mr. Pipes have no financial interests to disclose. The authors and their associates provide training and consultation about implementing NAVIGATE treatment that can include compensation. These activities started only after data collection for the article was completed. At the time of publication, Dr. Robinson had received compensation for these activities. Rights to the COMPASS system are held by the Feinstein Institute for Medical Research,

Schizophrenia Bulletin, 2017

12-month follow-up. Similar results were obtained when data were clustered following clinical dec... more 12-month follow-up. Similar results were obtained when data were clustered following clinical decision rules. Conclusion: Despite extensive neuropsychological investigations within CHR cohorts, this is one of the first studies to investigate NP clustering profiles as a contributor to heterogeneity in outcome. Our results indicate that the four NP profiles vary substantially in their outcome, underscoring the relevance of cognitive functioning in the prediction of illness progression. Our findings may tentatively suggest that individualized cognitive profiling should be explored in clinical settings, and my point to important directions for personalized treatment.

Schizophrenia research, May 24, 2017

Schizophrenia is a chronic disabling disorder for which current treatments are only partially eff... more Schizophrenia is a chronic disabling disorder for which current treatments are only partially effective. While the evaluation of novel interventions is a high priority, loss to follow-up is a major threat to validity. Pattern mixture modeling is a statistical technique that incorporates information on patterns of retention that may bias comparisons between randomized treatment groups. This study used pattern mixture mixed model (PMMM) in the analysis of outcomes of a two-year cluster-randomized trial, the Recovery after an Initial Schizophrenia Episode-Early Treatment Program, which compared a coordinated specialty care intervention called NAVIGATE to usual community care (CC). PMM-adjusted outcome differences between NAVIGATE and CC were estimated by the weighted-average of effects across the retention patterns. Compared to the original analysis, PMMM improved model fit and the estimated effectiveness of NAVIGATE as compared to CC. On the Quality of Life Scale NAVIGATE effectivenes...

The American journal of psychiatry, Sep 21, 2017

Social Security Administration (SSA) disability benefits are an important source of income for pe... more Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE inte...

Psychiatric services (Washington, D.C.), 2017

This study examined perceived support for autonomy-the extent to which individuals feel empowered... more This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups. This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure. The results indicated that perceived autonomy support increased significantly over time for those in NAVIGA...

Schizophrenia research, Mar 11, 2017

This study compared baseline characteristics of Black Americans and Caucasians with first-episode... more This study compared baseline characteristics of Black Americans and Caucasians with first-episode psychosis in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP). Black American (N=152) and Caucasian (N=218) participants were compared on demographic, psychosocial, clinical, and neurocognitive measures. Results indicated several notable racial differences in baseline characteristics: a greater proportion of Black Americans than Caucasians were female, and Black Americans reported less personal and parental education than Caucasians. Black Americans were also less likely to have private insurance, more likely to be homeless or transient, had significantly poorer quality of life, more severe disorganized symptoms, worse neurocognition, and were less likely to abuse alcohol than Caucasians. The implications of these findings are discussed, and suggestions are provided for future avenues of treatment and research on racial disparities in first-episode...

Schizophrenia research, Apr 8, 2017

We assessed the prevalence and correlates of lifetime substance use disorders in people with firs... more We assessed the prevalence and correlates of lifetime substance use disorders in people with first episode psychosis using the baseline data from the Recovery After an Initial Schizophrenia Episode (RAISE) Early Treatment Program study. Research staff assessed 404 first episode patients at 34 community mental health centers across the United States with the Structured Clinical Interview for DSM-IV for diagnoses of psychotic and substance use disorders. Logistic regression was used to evaluate the relationships between participant characteristics and lifetime substance use disorders, followed with generalized linear mixed-effects regression models to identify unique predictors of lifetime substance use disorders. Approximately one-third of participants reported recent alcohol use (36.6%) and cannabis use (30.7%), and one half (51.7%) met criteria for any lifetime alcohol or drug use disorder. Lifetime substance use disorders were associated with male gender, White race, higher excite...

Schizophrenia research, Jul 29, 2016

Recovery-oriented practices that promote client-centered care, collaboration, and functional outc... more Recovery-oriented practices that promote client-centered care, collaboration, and functional outcome have been recommended to improve treatment engagement, especially for individuals with serious mental illness (SMI). Psychological well-being (PWB) is related to recovery and refers to experiencing purpose and meaning in life through realizing one's potential. The recently completed Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP) study sought to improve quality of life, functional outcome, and well-being in individuals with first episode psychosis (FEP). Therefore, the primary aims of the present analysis were: 1) to examine the impact of treatment on PWB and mental health recovery trajectories, 2) to examine the impact of duration of untreated psychosis (DUP) on these outcomes, and 3) to examine the relationships among these outcomes and quality of life. Multilevel modeling was used given the nested data structure. Results revealed that PWB an...

Schizophrenia Research, 2017

Background: Participation in work and school are central objectives for first episode psychosis (... more Background: Participation in work and school are central objectives for first episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education (SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies. Methods: FEP participants (N = 404) at thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a comprehensive, team-based treatment program that included ≥ 5 h of SEE services per week, , grounded in many of the principles of the Individual Placement and Support model of supported employment combined with supported education services. All study participants were offered SEE regardless of their initial interest in work or school. Monthly assessments over 24 months recorded days of employment and attendance at school, days of participation in SEE, and both employment and public support income (including disability income). General Estimation Equation models were used to compare CC and NAVIGATE on work and school participation, employment and public support income, and the mediating effect of receiving ≥3 SEE visits on these outcomes. Results: NAVIGATE treatment was associated with a greater increase in participation in work or school (p = 0.0486) and this difference appeared to be mediated by SEE. No group differences were observed in earnings or public support payments. Conclusion: A comprehensive, team-based FEP treatment approach was associated with greater improvement in work or school participation, and this effect appears to be mediated, in part, by participation in SEE.

Psychiatric Services, 2015

American Journal of Psychiatry, 2015

Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode... more Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for firstepisode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients. Method: Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with firstepisode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry. Results: The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects. Conclusions: Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.

Psychiatric services (Washington, D.C.), Jan 15, 2015

Objective: This study is the first to examine duration of untreated psychosis (DUP) among persons... more Objective: This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States. Methods: Participants were 404 individuals (ages 15-40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states. DUP and individual- and site-level variables were measured. Results: Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings. Conclusions: This study reported longer DUP than studies conducted in academic settings but found similar correlates of DUP. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways ...

Schizophrenia Research, 2013

Alpha7 nicotinic acetylcholine receptor (α 7 nAChR) agonists may be valuable treatments for negat... more Alpha7 nicotinic acetylcholine receptor (α 7 nAChR) agonists may be valuable treatments for negative symptoms and cognitive impairment in schizophrenia. Unfortunately, chronic exposure to an agonist may reduce the receptor's sensitivity. Therefore, we combined CDP-choline, a dietary source of the direct agonist choline, with galantamine, a positive allosteric modulator (PAM) of nicotinic acetylcholine receptors, to improve the efficiency of transducing the choline signal and, possibly, preserve the receptor in a sensitive state. We conducted a single-site, doubleblind randomized clinical trial comparing galantamine/CDP-choline to placebos in schizophrenia patients with negative symptoms who were receiving second generation antipsychotics. Fortythree subjects received galantamine and CDP-choline or matching placebos for 16 weeks. The primary outcome measure was the 5-item Marder negative-symptoms factor of the Positive and Negative Syndrome Scale (PANSS). Cognition and functioning were also assessed. Trial completion was high; 79%. There was no significant treatment effect on negative symptoms, other PANSS symptom factors, or the MATRICS Cognitive Consensus Battery. There were significant treatment effects in overall functioning and a test of free verbal recall. Three subjects discontinued treatment in the active treatment group for gastro-intestinal adverse events (AE). The most

British Journal of Psychiatry, 2000

BackgroundFamily interventions for schizophrenia have proved to be highly effective in preventing... more BackgroundFamily interventions for schizophrenia have proved to be highly effective in preventing relapse, but it is not clear how they work or how they should be structured.AimsTo examine the effects of a behavioural family intervention and a family support programme on communication, problem solving and outcome in order to determine the impact of structured communication training.MethodPatients and family members participating in the Treatment Strategies in Schizophrenia study were videotaped engaging in 10-minute problem-solving conversations at baseline and after the conclusion of the family intervention. Tapes were subsequently evaluated for changes in communication patterns.ResultsThe intensive behavioural intervention did not produce differential improvement in communication, and change in communication was unrelated to patient outcomes.ConclusionsThe data suggest that intensive behavioural family interventions may not be cost efficient, and that change in family communicatio...

Archives of General Psychiatry, 2007

Context: Cognitive impairment in schizophrenia is frequent, involves multiple domains, and is end... more Context: Cognitive impairment in schizophrenia is frequent, involves multiple domains, and is enduring. Numerous recent clinical trials have suggested that secondgeneration antipsychotic medications significantly enhance cognition in schizophrenia. However, none of these studies included healthy controls undergoing repeated testing to assess the possibility that improvements might reflect simple practice effects. Objective: To report the results on cognition of a randomized comparison of 2 widely prescribed secondgeneration antipsychotic medications, olanzapine and risperidone, in patients with first-episode schizophrenia and a healthy control group. Design: Randomized clinical trial. Setting: Hospital-based research units. Patients: A total of 104 participants with first-episode schizophrenia and 84 healthy controls. Main Outcome Measures: Cognitive assessment of all study participants occurred at baseline, 6 weeks later, and 16 weeks later. Neurocognitive tests included measures of working memory and attention, speed, motor function, episodic memory, and executive function.