Title: Understanding Causes and Developing Effective Interventions For Schizophrenia and Other Psychoses
Funder: Department of Health (England)

Abstract: Aims and Objectives We aim to improve identification, diagnosis and outcome of psychotic mental illness through a programme of applied health services research & technology development. To achieve this aim we have the following objectives: 1. To define the incidence and social epidemiology of psychotic disorders and at risk mental states (ARMS) in Cambridgeshire & Peterborough, and establish cohorts for research that will allow us to understand causes and target services 2. To design reliable (efficient), brief, and valid assessment procedures for casemix, service use and outcome for longitudinal studies of these clinical populations, and to make these data available for prognostic research to study service variations 3. To investigate the factors associated with transition from at risk mental states to psychosis syndromes (true positives) and to characterise false positive referrals 4. To investigate the barriers to, and promoters of, functional recovery in at risk mental states and early psychosis, in particular with relation to substance misuse 5. To evaluate a range of effective interventions and service configurations aimed at improving early identification outcome and promoting recovery. Background Psychotic disorders are a huge burden because of their onset in early adulthood, chronic disability and high economic costs. Mental health services are prominent in the NHS plan, but they are far from perfect. This application brings together researchers, institutions and a service context to focus on a programme of applied research that will improve outcomes for people with psychotic mental illness. Research Plan We shall: 1. Put in place clinical surveillance and IT systems to identify and electronically record all cases of clinically relevant psychotic states in Cambridgeshire and Peterborough, linking with routine data capture for the mental health minimum data set and NHS Connecting for Health 2. Test the optimum way of finding ARMS through a cluster RCT of high vs low intensity liaison with Education & General practiceS to cultivate ARMS referrals and reduce DUP – the “LEGS” trial. 3. Compare clinical epidemiological data obtained in 1 & 2 with wider data that we have collected with our academic partners (ÆSOP, PsyGrid and EDEN studies), and devise realistically complex statistical models of ARMS and psychosis incidence. This will provide an epidemiologically based prediction tool for service development. 4. Establish a brief, multidimensional measurement battery for longitudinal recording of the clinical, social and cognitive aspects of psychosis in EIS service referrals. Undertake formal psychometric evaluations to establish how this can be used for assessing ARMS cases and tracking changes in patients who develop full psychosis. 5. To use follow-up information using our psychometrically and user-informed tools to compare outcomes in different parts of our service where there are different combinations of EIS and other service components. These will be at different stages of development, serving different populations. Applying appropriate modelling techniques will allow us to compare the effectiveness of these services without recourse to randomised designs, but indicating where RCTs are required. Research Team All applicants have successful research programmes in the disciplines of clinical psychology, public health and epidemiology, health services research and health technology assessment in primary care and methodological aspects of translational research. Research Environment This programme unites our research collaborations and academic links, particularly with the University of Cambridge Departments of Psychiatry, Psychology and Primary Care (all 5* in the 2001 RAE), and with the UK Mental Research Network and its Research Methodology Group. We have a strong track record in HSR/HTA R&D. Outputs 1. A web-deployed, evidence based EIS planning tool for the NHS that will predict the numbers requiring services by social geographies and area. 2. A simple, psychometrically-principled casemix and outcome assessment tool that will help describe service users and target interventions 3. Simple, user- and carer-focused measures of functional recovery outcome 4. Tools to detect at risk mental states in primary care and non-clinical settings e.g. schools, and promote useful care pathways. 5. Realistically complex understanding of person-place interactions in the genesis of disorder. 6. Knowledge of which interventions and configurations in our trust work, and which don’t. 7. Local understanding of who we treat, where they come from, what’s wrong, what we do for them, and what happens to them. 8. A blueprint for ongoing evaluation embedded in a mental health trust. Public Involvement Our trust has a robust commitment to user and carer involvement in the design, implementation, governance, and evaluation of our research.?This programme will build on this.????


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH