There has been an ongoing program of first episode treatment studies at The Zucker Hillside Hospital since the late 1970’s. Dr Robinson has been an integral part of these efforts since 1986. John Kane, MD and colleagues (1982) reported one of the earliest placebo-controlled studies, demonstrating the effectiveness of maintenance antipsychotic medication for the prevention of relapse in this patient population comparable to that in more chronic patients. The Hillside Psychobiology of First Episode Schizophrenia Study treated and assessed 118 first episode patients for a mean of 221 (SD=106) weeks. Important treatment findings from that study included a high rate of response for the initial episode (Robinson et al. 1999a), but also a high rate of relapse (Robinson et al. 1999b) and a low rate of recovery (Robinson et al. 2004).
In a study of 34 first episode patients who were treated with clozapine as their initial treatment and followed for a mean of 114 (SD=74) weeks, Woerner and colleagues (2003) found that clozapine did not have advantages over other antipsychotics for treatment of the initial episode of psychosis. The Preventing Morbidity study (Robinson et al. 2006) compared olanzapine and risperidone treatment with 112 patients with first episode schizophrenia. In contrast with the results of the CATIE trial with multi-episode patients, clinical outcomes with risperidone were as good or better than with olanzapine. Olanzapine compared with risperidone treatment was associated with more weight gain, but even with risperidone the mean BMI of participants increased from the normal to the overweight range after only 4 months of treatment.
The Preventing Morbidity trial initiated the current first episode study model. Subjects are recruited and treated in community settings. Assessment is centralized to maximize the quality of assessment using rater teams based at The Zucker Hillside. The current ongoing NIMH-funded first episode treatment trial, Preventing Morbidity, Part 2 compares treatment with aripiprazole and risperidone. The Hillside research group has developed a first episode schizophrenia research network, which includes not only sites in the New York Metropolitan area, but also in other parts of the country and in Canada serving diverse communities.
Our prior work has demonstrated the efficacy, but also the limitations of pharmacotherapy for schizophrenia. We have learned that social and vocational deficits often persist despite symptom remission and that the rate of recovery – defined by symptom remission and good functional outcome is disappointingly low (Robinson et al. 2004). These findings lead directly to the design of the RAISE contract funded to the Feinstein Institutes. RAISE treatment incorporates both psychosocial and pharmacological treatments. Outcomes of treatment with the RAISE treatment model and with usual care are compared at community facilities across the county.