Family Intervention in Recent Onset Schizophrenia Treatment (FIRST)

Study Overview
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Brief Summary
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The primary purpose of this study is to evaluate the overall effect of caregivers receiving a study-provided caregiver psycho-education and skills training program on the number of treatment failures (psychiatric hospitalization, psychiatric emergency room (ER) visit, crisis center visit, mobile crisis unit intervention, arrest/incarceration, and suicide or suicide attempt) in patients under their care during a 12 month period.

Detailed Description
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This is a randomized, open-label, parallel group study of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder and their caregivers. Study will consist of a paired patient and caregiver. Patients will receive routine treatment, which may include oral antipsychotics or paliperidone palmitate, as directed by their treating physician. Caregivers for patients whose routine treatment is paliperidone palmitate will be randomized to receive either a study-provided caregiver psycho-education and skills training or usual caregiver support. Caregivers for patients whose routine treatment is oral antipsychotics will be randomized to the same Study Groups: Study Group 1: Study-provided caregiver psycho-education and skills training. Study Group 2: Usual caregiver support (caregiver support that is customarily provided by the study site, if any). Patients-caregiver pairs will be followed for up to 12 months following baseline assessment. Cumulative number of treatment failures over 12 months will be assessed primarily.

Official Title
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A 12-Month Randomized, Open-Label Study of Caregiver Psycho-education and Skills Training in Patients Recently Diagnosed With Schizophrenia, Schizoaffective Disorder, or Schizophreniform Disorder and Receiving Paliperidone Palmitate or Oral Antipsychotic Treatment

Conditions
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Schizophrenia

Intervention / Treatment
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* Other: Caregiver psycho-education and skills training
* Other: Caregiver support available at the study site
* Drug: Paliperidone palmitate
* Drug: Chlorpromazine
* Drug: Droperidol
* Drug: Fluphenazine
* Drug: Haloperidol
* Drug: Loxapine
* Drug: Perphenazine
* Drug: Pimozide
* Drug: Prochlorperazine
* Drug: Thiothixene
* Drug: Thioridazine
* Drug: Trifluoperazine
* Drug: Aripiprazole
* Drug: Asenapine
* Drug: Clozapine
* Drug: Iloperidone
* Drug: Olanzapine
* Drug: Paliperidone
* Drug: Quetiapine
* Drug: Risperidone
* Drug: Ziprasidone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A) Caregivers Each caregiver must sign an informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study and are willing to participate for the duration of the study Caregiver is able to have verbal interaction with the patient with schizophrenia, schizoaffective disorder, or schizophreniform disorder at least twice a week, per self-report B) Patients Patients must have a clinical diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder made by a clinician with understanding of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) criteria for these disorders Patients must be receiving ongoing psychiatric treatment at the study site and must be receiving oral antipsychotics or paliperidone palmitate long acting therapy Exclusion Criteria: A) Caregivers Caregiver is mentally or physically incapable of adequately performing the required study procedures, as determined by the treatment team Caregiver has received structured or manualized psycho-education or skills training within 1 year prior to Screening B) Patients Patient is hospitalized (medical or psychiatric), incarcerated, or otherwise institutionalized at time of randomization Patient is considered to have significant potential for imminent harm to self and/or others as based on the judgment of the treatment team Patient is receiving assertive community treatment (ACT) or other high intensity case management services to prevent hospitalization

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study group 1<br>Caregivers randomized to this group will receive up to 16 sessions of study-provided caregiver psycho-education and skills training sessions they are able to attend within a 6-month period. Each patient will be paired with a caregiver and patients will continue their routine antipsychotic treatments prescribed by their treating physician. | Other: Caregiver psycho-education and skills training<br>* Caregivers will receive up to 16 sessions of study-provided caregiver psycho-education and skills training sessions they are able to attend within a 6-month period.<br>Drug: Paliperidone palmitate<br>* Patients enrolled in this study will continue to receive routine treatment of paliperidone palmitate, as directed by their treating physician.<br>Drug: Chlorpromazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Droperidol<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Fluphenazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Haloperidol<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Loxapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Perphenazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Pimozide<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Prochlorperazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Thiothixene<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Thioridazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Trifluoperazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Aripiprazole<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Asenapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Clozapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Iloperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Olanzapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Paliperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Quetiapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Risperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Ziprasidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>|
| Study group 2<br>Caregivers randomized to this group will receive whatever caregiver support that is customarily available at the study site, if any. Each patient will be paired with a caregiver and patients will continue their routine antipsychotic treatments prescribed by their treating physician. | Other: Caregiver support available at the study site<br>* Caregivers will receive whatever caregiver support that is customarily available at the study site, if any.<br>Drug: Paliperidone palmitate<br>* Patients enrolled in this study will continue to receive routine treatment of paliperidone palmitate, as directed by their treating physician.<br>Drug: Chlorpromazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Droperidol<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Fluphenazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Haloperidol<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Loxapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Perphenazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Pimozide<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Prochlorperazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Thiothixene<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Thioridazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Trifluoperazine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Aripiprazole<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Asenapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Clozapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Iloperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Olanzapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Paliperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Quetiapine<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Risperidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>Drug: Ziprasidone<br>* Patients enrolled in this study will continue to receive routine treatment of oral antipsychotics, as directed by their treating physician.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Treatment Failures Over 12 Months | Treatment failure is defined as any of the following: Psychiatric hospitalization Psychiatric emergency room (ER) visit Crisis center visit Mobile crisis unit intervention Arrest/Incarceration Suicide or suicide attempt. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Caregiver Burden Based on Involvement Evaluation Questionnaire (IEQ) Total Score at Month 12 | The IEQ is designed to measure levels of caregiver consequences among family members and friends of patients with schizophrenia. The 31 items included in this scale are answered on a 5 point Likert response scale and address consequences among 4 dimensions (tension, supervision, worrying, and urging). | Month 12 | 
| Number of Treatment Failures in Patients Taking Oral Antipsychotics | Treatment failure is defined as any of the following: Psychiatric hospitalization Psychiatric emergency room (ER) visit Crisis center visit Mobile crisis unit intervention Arrest/Incarceration Suicide or suicide attempt. | 12 months | 
| Number of Treatment Failures in Patients Taking Paliperidone Palmitate | Treatment failure is defined as any of the following: Psychiatric hospitalization Psychiatric emergency room (ER) visit Crisis center visit Mobile crisis unit intervention Arrest/Incarceration Suicide or suicide attempt. | 12 months | 
| Patient Recovery Based on Total Illness Management and Recovery (IMR) Score | The IMR program was developed in order to help patients with schizophrenia or major mood disorders learn how to manage their illnesses more effectively in the context of pursuing their personal goals. | Month 6 and Month 12 | 
| Change From Baseline in Clinical Global Impression - Severity (CGI-S) at Month 12 | The CGI-S rating scale is used to rate the severity of a patient's overall clinical condition on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal) to 7 (amongst the most severely ill patients). | Month 12 | 
| Change From Baseline in 12- Item Short Form Health Survey (SF-12) at Month 12 | The 12-item Short Form Health Survey (SF-12) is a self-administered, generic, 12-item questionnaire designed to cover the same 8 domains of functional health status and well-being included in the longer 36-item Short Form Health Survey (SF 36): physical functioning, role limitations due to physical health problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. | Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Schizophrenia, Caregiver, Psycho-education and skills training, Paliperidone Palmitate, Oral Antipsychotic