Inpatient Evaluation of Adults With Schizophrenia

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT00001247
First received: November 3, 1999
Last updated: March 14, 2014
Last verified: March 2014

November 3, 1999
March 14, 2014
September 1989
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Complete list of historical versions of study NCT00001247 on ClinicalTrials.gov Archive Site
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Inpatient Evaluation of Adults With Schizophrenia
Inpatient Evaluation of Neuropsychiatric Patients

The purpose of this study is to understand the biologic basis of schizophrenia and to determine which symptoms are related to the illness itself and which are related to medications used to treat the illness.

Schizophrenia and related psychoses are chronic brain disorders whose prognosis is often poor and whose pathophysiology remains obscure. Brain imaging technologies such s positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and magnetic resonance imaging (MRI) offer opportunities to study the pathophysiology of psychotic disorders by evaluating brain function. However, the use of anti-psychotic drugs may interfere with the results of such studies. In this study, psychotropic medication will be discontinued in patients for a short period of time to distinguish the effects of the illness on the brain without the interference of the medication's effects on the brain. Given that there is a risk that the patient's symptoms will increase, they are asked to stay on an inpatient unit where the NIMH clinical staff is available to help them 24 hours a day.

This study will be conducted in three phases. In Phase 1, participants will be admitted to the Clinical Center while continuing to take their medication and will undergo diagnostic interviews, physical and laboratory assessments, physiological monitoring, and neuropsychological testing. Behavioral ratings will also be performed and blood and urine samples will be collected. During Phase 2, participants will continue taking medications in a blinded fashion for 8 to 12 weeks. The active medications will be replaced with a placebo (an inactive pill) part of that time. PET, fMRI, and MRI scans will be used to monitor how the continuation or lack of medication affects the brain. Psychological tests will also be given to measure changes in cognition. In Phase 3, participants will have the opportunity for clinical stabilization.

Schizophrenia and related psychoses are chronic brain disorders whose prognosis is often poor and whose pathophysiology remains obscure. Neuroimaging technologies such as PET (positron emission tomography), fMRI (functional magnetic resonance imaging), DTI (diffusion tensor imaging) and MRSI (magnetic resonance spectroscopic imaging) offer opportunities to elucidate the pathophysiology by studying brain function in living patients. The use of these techniques to study psychotic disorders is severely limited, however, by a critical methodological confound: neuroleptic treatment. The purpose of this protocol is to admit patients with schizophrenia and other related disorders to the Clinical Center, carefully evaluate their neuropsychiatric status, and discontinue psychotropic medications for a brief period so patients can be studied without the confound of neuroleptic treatment. There are several phases to this protocol. The first phase is the evaluation phase and includes gathering historical data, structured diagnostic interviews, general physical and laboratory assessments, basic physiological monitoring, neuropsychological testing, limited collection of blood and urine samples, and serial behavioral ratings. In the second phase, patients will receive blinded compounds that will contain inactive placebo or active neuroleptic administered in a double blind, crossover fashion. Each arm normally lasts 4 to 6 weeks. The total duration of this phase is 8 to 12 weeks. During the coded neuroleptic period, patients are enrolled in a series of neuroimaging and other approved protocols designed to elucidate the neurobiology of these disorders. These include studies using PET, fMRI, DTI, and MRSI. The neuroleptic free period is essential to distinguish the effects of illness versus medication. Parameters under investigation include traits that are candidate phenotypes for genetic studies and state-dependent aspects of brain function. The combined use of many neuroimaging modalities will allow us to look at the functional relationship between a variety of brain abnormalities hypothesized to play a role in schizophrenia. These include hippocampal neurochemical abnormalities, deficits in prefrontal cortical activation, and dysregulation of subcortical dopamine in a single patient.

Observational
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  • Psychotic Disorder
  • Schizophrenia
  • Schizoaffective
  • Paranoia
  • Psychosis
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*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
600
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  • INCLUSION CRITERIA:

Inpatients admitted to the CBDB inpatient program at the Clinical Center must be:

age 18 or older

Male or female

Schizophrenia, schizoaffective disorder, and psychosis NOS. Subjects with other neuropsychiatric disorders may also be admitted and participate in the protocol if there is sufficient evidence to believe they have an underlying, undiagnosed schizophrenia, schizoaffective disorder, or psychosis NOS.

EXCLUSION CRITERIA:

Subjects identified as having major medical problems other than their primary neuropsychiatric disorder will be excluded from admission.

Patients judged to be unsuitable for medication free studies will also be excluded. Possible reasons for exclusion include prior history of dangerousness to self or others, particularly when off medication.

Inability to give consent

Because of the long half life of depot medications, applicants are not admitted if they have received a depot injection within 3 months, although exceptions may be made.

Both
18 Years and older
No
Contact: Jose A Apud, M.D. (301) 594-6561 apudj@mail.nih.gov
United States
 
NCT00001247
890160, 89-M-0160
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National Institute of Mental Health (NIMH)
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Principal Investigator: Jose A Apud, M.D. National Institute of Mental Health (NIMH)
National Institutes of Health Clinical Center (CC)
March 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP