This core provides specialized diagnostic and psychiatric symptom assessment training, quality assurance procedures and best strategies for measuring psychosocial and functional outcomes for individuals with schizophrenia. In addition, the Core provides continued development and psychometric testing of measures relevant to functional outcomes in schizophrenia.
The primary function of the Chronic Schizophrenia Recruitment and Assessment Core is to recruit and clinically assess chronic schizophrenia patients and demographically comparable normal subjects for participation in studies of the Center. This Core screens, recruits and conducts diagnostic interview with the potential patient subjects and the normal comparison subjects. This Core also completes ratings of symptom severity and functional outcome for all chronic schizophrenia patients who participate in Center projects.
It is unclear whether insight into having a mental disorder deteriorates or improves over the course of schizophrenia. We compared levels of insight between the first-episode and chronic patients, and within a small subset of patients who also had insight data available at two earlier time points from participation in previous longitudinal studies (Subotnik 2006).These results indicate that that schizophrenia patients’ insight improved over time, but that most of the improvement occurred during the initial year of outpatient treatment. We then examined the associations between insight and measures of dual-task processing, episodic memory, social cognition, and emotion reactivity among the patients in the first-episode core and the chronic schizophrenia core (Subotnik 2007).Results suggest that the awareness of having a mental disorder shares some characteristics with understanding what other people are thinking and the reasons for their behaviors. Impairment in memory and attention resulted in difficulty in being aware of one’s own problems in these domains. The improvement seen over time might explain the attenuated relationships seen among the chronic schizophrenia patients.
The Aftercare Research Program is an outpatient research clinic that provides the clinical site for the recruitment, pharmacological and psychosocial interventions, and assessments of symptoms and functional outcome for first-episode patients who are participating in research projects in this Center. The primary mission of the Aftercare Research Program is to provide a structured and high quality clinical care setting within which this Center research can take place. The Aftercare Research Program provides a centralized and standardized process for screening and diagnosing first-episode schizophrenia patient participants, providing their clinical services and completing high-quality longitudinal assessments of symptoms, work functioning, and social functioning.
Dr. Nuechterlein presented an overview of the last 20 years of research conducted at the UCLA Aftercare Research Program at the Semel Institute Grand Rounds on November 1, 2005.
We examined the impact of medication nonadherence on return of positive symptoms among the first-episode schizophrenia patients in the Aftercare Research Program (Subotnik et al. 2008). More frequent adherence assessments and better operational criteria for nonadherence were utilized than those found in most prior studies. Although we expected that medication nonadherence would predict a return of psychotic symptoms, it was noteworthy that even relatively brief periods of partial antipsychotic nonadherence predicted psychotic symptom return (risk ratio = 4.2). We also found that two types of formal thought disorder (i.e., bizarre-idiosyncratic and concrete thinking) were related to impairments in verbal learning, intrusions in verbal memory, immediate auditory memory, sustained attention, and social schema knowledge. The pattern of findings is consistent with the view that neurocognitive and social cognitive deficits underlie these two aspects of formal thinking disturbance in schizophrenia. We also created and published an operational system for identifying relapse, exacerbation, and remission of schizophrenia for use within longitudinal studies that involve repeated symptom assessments (Nuechterlein et al. 2006). A computer program is available to facilitate its use. Use of these explicit definitions of episodes may help to clarify relationships between episodic outcome and other fundamental domains of illness outcome, particularly other symptom dimensions, work functioning, and social functioning.
Research into Schizophrenia at UCLA
Our projects range from those addressing relatively basic neurocognitive processes, to addressing primarily emotional processes, and the interface between them.