RESEARCH

The mission of the Advanced Center for Innovation in Services and Intervention Research (ACISIR) is to improve the quality of life of middle-aged and older adults with psychotic disorders through the development, implementation, and dissemination of evidence-based practice through community partnerships. The Center infrastructure is aimed at fostering research and education that result in pragmatic knowledge, innovative psychosocial instruments and interventions, and cultural competence in delivering services to the underserved. Active partnership with community stakeholders at every stage of research protocol development, evaluation, implementation, and dissemination will be a critical element of our work. The Center will build on and expand its established community partnerships; foster interdisciplinary collaboration; develop, evaluate, and disseminate innovative methods; and cultivate opportunities for new investigators, clinicians, front-line mental health workers, and consumers to improve the care of older persons with psychosis. Our primary community partner is San Diego County’s Adult and Older Adult Mental Health Services (AOAMHS).

Below are a number of studies we are currently recruiting participants for:

Cognitive Behavioral Skills Training for Schizophrenia
PI: Eric L. Granholm, PhD
Contact Information: Sherry Edwards, BA (858-552-8585 x2275)

This is a randomized-controlled clinical trial comparing two treatment conditions: Treatment as usual (TAU) + supportive contact (SC); and TAU + Cognitive Behavioral Social Skills Training (CBSST). Subjects with SCID-IV diagnosis of schizophrenia or schizoaffective disorder (N=240) will be recruited, treated for 9 months and followed longitudinally for 12 months after treatment. The primary outcome is psychosocial functioning, but neuropsychological functioning, cognitive insight, psychotic symptoms, health services utilization, and CBSST skills acquisition will be assessed at baseline, end of treatment (9-months after baseline), and 9 months after treatment (18 months after baseline).

Managing the Medical Side Effects of Antipsychotics in Community Mental Health Centers
PI: David Folsom, M.D.
Contact Information: Michael Jenkins, Study Coordinator

David Folsom, M.D. and colleagues at the UCSD Department of Psychiatry are conducting a research study to learn more about monitoring for and managing weight gain, elevated blood pressure and elevated blood glucose (sugar) in people taking antipsychotic medications. The purpose of this study is to compare different ways of managing the medical side effects of antipsychotic medications.

Functional Rehabilitation of Older Patients with Schizophrenia (FROPS)
PI: Eric L. Granholm, PhD
Contact Information: Sherry Edwards, BA (858-552-8585 x2275)

In prior trials, Cognitive Behavioral Social Skills Training (CBSST) improved functioning (e.g., everyday living skill performance) in older people with schizophrenia. CBSST, however, is an intensive program that burdens mental health clinics with demands for additional staff and financial resources and burdens older veterans with demands for time and travel. To reduce these burdens and barriers to implementation of CBSST, we developed a computer-assisted CBSST intervention that takes advantage of available handheld computer technology. Therapist contact is reduced by half and supplemented by handheld computer-assisted intervention tools. The proposed project will examine whether computer-assisted CBSST improves functioning in older veterans with schizophrenia to the same extent as the full CBSST program, while improving patient satisfaction and reducing burden and cost. This is a randomized-controlled clinical trial comparing three treatment conditions (all include treatment as usual): CBSST alone (24 sessions), computer-assisted CBSST (12 sessions), and a computer-assisted Supportive Contact (SC) control condition (24 sessions). Subjects (N=162; based on power analyses) will be recruited, treated for 6 months and followed longitudinally for 6 months after treatment.

An Intervention to Increase Physical Acticity in Schizophrenia
PI: Laurie Lindamer, Ph.D.
Contact Information: Jorge Gutierrez at (858)642-3262

The purpose of this study is to determine whether an educational program will increase physical activity and improve the quality of life of its participants. This study aims to decrease weight, lower blood pressure, and improve eating habits of adults with mental illness.

This is a 3 year study that is currently being held out in various Board and Cares withing the San Diego County. This study aims to educate either schizophrenic or schizo-affective residents to become more involved in physical activity
within their own community settings since that is where they reside and are likely to benefit from walking as a main source of mild to moderate physical activity.

Comparison of Video Consent and Routine Consent for Research
PI: Dilip Jeste, M.D.
Contact Information: Jorge Gutierrez at (858)642-3262

The purpose of this study is to learn more about ways to improve the informed consent process used in research studies.

This is a 5 years study that is currently being administered at the VASDHS or out in the community in either Board and Cares or private residences. We are currently assessing control subjects (with no history of (mental illness) and schizophrenic/schizo-affective subjects. This study aims to improve in the administration of the informed consent process in order to give participants a better understanding of the factors which impact a patients abilities to make fully informed decisions about their own treatment.

Ecological Momentary Assessment (EMA) in Patients with Psychosis
PI: Eric L. Granholm, PhD
Contact Information: Sherry Edwards, BA (858-552-8585 x2275)

EMA is an ambulatory data collection technique that permits the real time, real world monitoring of behaviors, moods, and cognitions. Participants are signaled several times throughout the day to respond to questionnaires. Recent EMA applications using microcomputer devices (EMAc) provide a cost effective means of collecting ecologically valid data about the daily lives of middle-aged and older people with psychosis that can be used to improve disease management. The primary focus of this pilot study will be on EMAc monitoring of social isolation, moods, symptom severity, and medication adherence, and providing patients and care providers with feedback about daily and weekly changes in these domains. We will focus on two key issues: (1) Identifying and addressing implementation factors that will facilitate or hinder successful uptake and use of EMAc methods; and (2) Engagement of stakeholders in the development and implementation process. Participants with psychotic disorders (n=110) age 45 or older will be given the devices, which will prompt for self-reports of environmental context, functioning behaviors, symptoms, moods, and attributions. The next step after empirical validation of the EMAc method, is to determine whether the method can be implemented in the community.

Tai Chi: Well-being and Heart Failure
PI: Laura Redwine, Ph.D.
Contact Information:
Stephanie Cammarata - scammarata@vapop.ucsd.edu 858-552-8585 ext. 3866
Ines Pandzic - ipandzic@vapop.ucsd.edu 858-552-8585 ext. 3866

The purpose is to compare the effects of a Tai Chi intervention, standard exercise and health-education in adults with congestive heart failure (CHF) for well-being (depression, quality of life and fatigue), inflammatory cytokines (TNF, IL-6, IFN, IL-10) and physical function at 12 and 24 weeks post-intervention.

This is a randomized study where Class II CHF patients are assigned to one of three interventions. The patient s physicians and nurses and individuals assessing patients are blinded to the intervention conditions. This is a prospective study where physiological and psychological assessments are taken at T1, T2 and T3 in 12-week intervals with interventions occurring between T1 and T2. Dr. Alan Maisel, a cardiologist and a co-Investigator, supervises recruitment at VASDHS. Assessment visits occur at the General Clinical Research Center at the University of California, San Diego, where blood is drawn for cytokine, neurohormone and BNP levels. During the sessions questionnaires are administered for quality of life, depression and global heart failure symptom severity and dyspnea. A 6-minute walk task is given at all three time points. Ejection fraction is determined at T1 as a criteria for inclusion into the study. Assessment testing takes approximately one hour. Patients participate in the study for 24-26 weeks. It is hypothesized that participants with CHF randomized to the Tai Chi group will show significant increases in well-being, reductions in depressed mood and increases in quality of life 12 and 24 weeks post-intervention relative to participants in the other groups. They will show significant reductions in cytokines, TNF and IL-6, cardiac hormone, BNP and increases in distance walked in the 6-minute walk test at 12 and 24 weeks post-intervention. Tai Chi classes have been taught by Tai Chi instructor, Dan Halpain for the past two years in the Spinal-Cord injury dining room at VASDHS. A licensed, registered nurse with access to a crash cart has been contracted through VMRF to supervise the class for the past two years.