From the Director's Office

Robert P. Liberman, M.D.
Center Director

The Research Center continues to make its transition from a Clinical Research Center to an Intervention Research Center, with constructive input from NIMH staff officials, our Center's Research Advisory Panel, and, most importantly, from a series of biweekly meetings that have been initiated to increase the level of participation of investigators in collaborative, interdisciplinary intervention research projects. The "bottom line" for our Center--now and for the future--will be our ability to generate pilot and independently funded, biobehavioral treatment and rehabilitation projects for the severely mentally ill. To this end, our Center's new name is: UCLA Center for Research on Treatment & Rehabilitation of Psychosis.

Psychotic disorders in the schizophrenia spectrum, as well as in the affective disorders, will be proper subjects for our studies. In addition, we shall include treatment and rehabilitation projects that include other disorders that produce enduring disability and symptomatic and cognitive impairments in those afflicted. Thus, obsessive-compulsive disorder, body dysmorphic disorder, schizotypal personality disorder, borderline personality disorder, dually diagnosed and comorbid disorders (e.g., mental retardation with psychosis; substance abuse with psychosis), and recurrent and disabling depressive disorders will be included in our focus. Finally, the types of clinical problems that will be targets for our intervention research will be purposefully widened to include understudied topics in psychosis such as stabilization of patients who are in frequent crisis and who have frequent relapses; assaultiveness; patients who are refractory to conventional treatments because of refractoriness and severe thought disorder: and psychotic individuals who are criminal offenders or who are homeless.

While one dimension of our renewed priorities will be an expanded spectrum of clinical populations, problems and mental disorders, two other dimensions will be a broader set of research sites where studies will be performed and an emphasis on innovative interventions for research and development. New research sites will be cultivated for performing intervention projects, such as community mental health centers, psychosocial rehabilitation programs, forensic psychiatric hospitals, and prisons. Resources will be used to develop and test novel interventions such as selegiline, cycloserine and glycine for negative psychotic symptoms, behavioral shaping procedures for overcoming attentional deficits in thought disordered patients, and cognitive-behavioral treatments such as errorless learning and cognitive remediation.

These new priorities are in accord with the mandate of our conversion to being a center for research on interventions and with the new priorities of the NIMH, our funding agency. The Director of NIMH, Steven E. Hyman MD, has stated: "To help psychiatrists and other clinicians provide optimal care to patients, we need to conduct treatment trials with larger sample sizes and with fewer exclusion criteria, ensure that trials occur not only in academic clinics but also in more real-world settings, and assess outcome not only on the basis of symptom reduction but also on measures of functional rehabilitation. [....] The information sought should be geared toward helping clinical decision-making in real-world settings and should demonstrate the types of functional outcomes that managed care organizations, employers, [public mental health agencies, patients, and advocacy groups] find compelling."

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