Early Psychosis

U.C. Davis Schizophrenia Research and Education Program

Background

Schizophrenia is a chronic, severely debilitating mental illness that affects 1% of the population worldwide. The personal and social costs of this illness are enormous. For example, schizophrenia accounts for ten percent of the permanently and totally disabled persons supported by the disability assistance programs (SSI and SSDI) of the United States Government. Schizophrenia affects males and females equally and typically has its onset in late teens and young adult years. The intermittent episodes of psychosis respond to available treatments and alternate with periods of relative remission but persistent cognitive, social and occupational disabilities are devastating for patients and for their families.

Improving outcome in schizophrenia depends upon two new developments in the field.

1. Early diagnosis and risk prediction to prevent or reduce the cognitive, social and occupational deterioration that characterizes established schizophrenia.
2. The development of targeted therapies, based on an understanding of the underlying brain disturbances that cause cognitive and social decline in patients with the illness.

The Department of Psychiatry at the University of California at Davis is a primary provider of care for patients with schizophrenia in Sacramento County, at the Mental Health Treatment Center and through contractual arrangements with non-profit agencies who provide ambulatory services to this population in the County. Dr Hales, the Chairman of the Department of Psychiatry, is also the Medical Director of the County Department of Mental Health. The Department also has one of the foremost basic neuroscientists focusing on schizophrenia, Dr Ted Jones, who has pioneered the use of modern molecular biology in the investigation of altered brain organization in post-mortem tissues in the illness. There is a group of investigators at the MIND institute, including Dr's Bob Hendren, Sufen Chiu, and Marjorie Solomon who are investigating relationships between schizophrenia and other developmental disorders such as autism. Finally, a group of clinical neuroscientists at the Translational Cognitive and Affective Neuroscience Program including Dr's Cameron Carter, Michael Minzenberg, J. Daniel Ragland, Stephan Ursu and Jong Yoon are using cognitive neuroscience and functional brain imaging methods to better understand cognitive control, working memory, episodic memory and social cognition deficits in schizophrenia.

The early schizophrenia program has both clinical and research components. The clinical component consists of the EDAPT and EDIPPP clinics that provide comprehensive treatment for young adults who have developed schizophrenia or a related psychotic disorder, as well as diagnostic and treatment services for at-risk patients and their families who are experiencing what might be prodromal symptoms of the illness.

The research component uses state of the art clinical and cognitive assessments, structural and functional brain imaging methods and genetic analyses to understand the causes of schizophrenia, especially the disabling and treatment refractory cognitive and social deficits associated with the illness.

Clinical Infrastructure

EDAPT (Early Diagnosis and Preventive Treatment) Clinic

EDAPT is an ambulatory clinical and research program based in the Department of Psychiatry and Behavioral Sciences at the University of California at Davis, in Sacramento California. This program is founded upon 13 years of clinical and research experience with early psychosis patients by the program director Cameron Carter, M.D. The EDAPT Clinic provides comprehensive diagnostic and treatment services for children and young adults who have recently developed or are at high-risk of developing a psychotic disorder. The goals of the clinic are to intervene as early as possible to mitigate illness progression, prevent development of disease-related impairment, and limit treatment-related side effects. Through this work we have empowered individuals to become active participants in their treatment and to make significant progress toward their personal, social, and occupational goals. Treatment is offered by a multi-disciplinary team composed of child (Dr's Rubinder Bangoo and Sufen Chiu) and adult psychiatrists (Dr's Cameron Carter, Jong Yoon and Michael Minzenberg), psychologists (Dr's J. Daniel Ragland, Kathleen Boyum, Marjorie Solomon), a licensed clinical social worker (Jane Dube), and several psychiatry residents and social work interns.

EDIPP (Early Detection and Intervention to Prevent Psychosis) Clinic

UC Davis is one of four sites in the nation to receive funding from The Robert Wood Johnson Foundation (RWJF) for an EDIPP clinic. EDIPP is based on the Portland Identification and Early Referral (PIER) program developed by Dr. William McFarlane and colleagues in Portland, Maine. EDIPP provides a combination of psychosocial, rehabilitative and pharmacologic interventions including: family psychoeducation, family-aided assertive community treatment, supported education or employment, and low-dose antipsychotic medication. The goal of this multidisciplinary program is to identify individuals at very early stages of the illness and provide them and their families with a multi-dimensional treatment approach designed delay or prevent onset of an acute psychotic disorder. In order to achieve this mission EDIPP has fostered culturally diverse community partnerships across the Sacramento area. In collaboration with the UC Davis Center for Reducing Health Disparities and the Medical Interpreting Services department these school, primary care, and community partnerships help to assure that community education and assessment is done in a culturally and linguistically competent manner.