November 18, 2002

UCSD & County Mental Health to Collaborate on Intervention and Services Research for Older Adults with Psychotic Disorders

National Institute of Mental Health Funds UCSD
Advanced Center for Interventions and Services Research

Older adults suffering from psychotic disorders such as schizophrenia a devastating, misunderstood and puzzling illness that dramatically alters an individual's thoughts, behavior and mood are the focus of a unique collaborative program between the University of California, San Diego (UCSD) School of Medicine and the San Diego County Health and Human Services Agency's Adult and Older Adult Mental Health Services (AMHS).

Called the Center for Community-based Research in Older People with Psychoses, the program is funded by a $7.5 million, five-year grant to UCSD from the National Institute of Mental Health (NIMH). The primary community partner for the UCSD program is the AMHS, which has access to treatment and clinical trials. The goal is development of effective new therapies for middle-aged and elderly people with schizophrenia and other chronic psychotic disorders.

The program addresses an impending crisis with the growing number of middle age and elderly individuals with psychotic disorders, said the program's principal investigator Dilip Jeste, M.D., UCSD Estelle and Edgar Levi Chair in Aging, professor of psychiatry and neurosciences, and director of the Division of Geriatric Psychiatry. Jeste also heads the geriatric psychiatry program at the VA San Diego Healthcare System.

As the baby boomer generation ages, the number of people in the U.S. over age 65 is projected to double from about 35 million today to nearly 70 million by 2030. According to a landmark report in the September 1999 Archives of General Psychiatry, the number of elderly Americans who suffer from a mental illness is projected to grow to approximately 15 million by 2030, compared to about 4 million reported in 1970.

"Younger adults who have a serious mental illness, such as schizophrenia, currently have a significantly shorter life span than those without mental illness," Jeste said. "The average life span of these patients will increase, thanks to improved medication and other treatments. In addition, as people in the general population live longer, they will have a greater chance of developing certain psychiatric problems in later life."

Schizophrenia affects about 1 percent of the population. Middle-aged and older adults with schizophrenia the focus of the UCSD/County program often live alone, in homeless shelters, or on the street. Tormented by hallucinations, delusions and other forms of bizarre behavior, these individuals are usually unable to work or interact with society. These patients mainly include those who developed schizophrenia as adolescents or young adults and are now middle-aged or elderly, while a small proportion of the older patients have developed the illness for the first time in their later years (late-onset schizophrenia). One area of interest is the possibility of remission of schizophrenia in old age as illustrated in the recent Oscar-winning movie "A Beautiful Mind, " based on the true life story of John Nash, a Nobel laureate.

The NIMH award to UCSD is one of only three collaborative mental-health programs in the U.S. funded by the mental health agency to develop new treatment strategies for mental illness by combining the strength of university research with the breadth of community services. The other two programs are located at the Universities of Pennsylvania and Pittsburgh.

Called Advanced Centers for Interventions and Services Research by the NIMH, each of the three new programs has a unique focus. The San Diego program will address psychosis in older adults. The University of Pennsylvania center will study depression in the elderly while the center at the University of Pittsburgh will focus on mental disorders in children.

UCSD was chosen for the award based on its expertise in older-adult mental health, especially in the area of psychotic disorders. For the past 10 years, UCSD's Jeste has had the only NIMH-funded center specifically devoted to studying middle-aged and older adults with psychotic disorders.

Participating with UCSD in the new NIMH-funded program, San Diego County's AMHS hopes to improve patient intervention and treatment services by drawing upon UCSD's research expertise. In turn, the collaboration will allow UCSD to expand its investigations to include individuals who are living in assisted living centers, attending community programs, or are homeless.

"We see this as an excellent opportunity to use best-practice research to develop new interventions that are age-appropriate and culturally relevant," said Mark Refowitz, AMHS director. "We have so many unmet needs in this county. Unfortunately, we don't have the capacity to do research that determines the most effective, evidence-based practices. UCSD will be a wonderful partner in this endeavor."

"Our collaboration will allow the university to expand studies to a large number of patients in multi-cultural communities and various community settings. In addition, we will be able to include additional measurements of treatment effectiveness, such as quality of everyday life for these individuals," Jeste said.

He added that adults with schizophrenia and related psychotic disorders are much more likely to be in public healthcare systems than in private ones. This is even truer for older adults who are less likely to have family caregivers. Many of these patients are consumers of the AMHS (including county-run clinics such as the San Ysidro Mental Health Clinic, South Bay guidance, and the Maria Sardinas Center), with a sizeable proportion receiving treatment at the VA San Diego Healthcare System, which will also participate in the new program. In addition, numerous assisted care facilities, homeless shelters, and psychiatric centers are expected to participate in the program.

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