CLEAR: (CLozapine in EARly psychosis) A Multi-Centre, Randomised Controlled trial of Clozapine for Young People with Treatment Resistant Psychosis in Real World Settings

Addressing priority 1: NIHR research in progress.

Schizophrenia usually starts in the twenties but it can begin during childhood or adolescence, when it is often more severe, causing many problems for the person and their family. The main treatment for it is antipsychotic medication. If not treated, symptoms typically carry on for many years, so it is vital to get effective treatment as soon as possible. Research shows that one antipsychotic, clozapine, works better than any other antipsychotics, and that clozapine has the best chance of working if people start it early on in treatment. On the other hand, clozapine has more side effects than some other antipsychotics, so doctors only use it when other drugs haven't helped. For this reason, almost all research on clozapine was done with adults for 25 and over who had already taken several other antipsychotic medications over the years. Because the illness so often starts in the teens or early twenties, we need to get a better understanding of what could help younger people. Three well designed studies suggest that clozapine works better than other antipsychotics in children and young people, but the studies were too small to be conclusive. This study will look at clozapine as a treatment for schizophrenia and similar illnesses in young people. It will recruit only people under twenty five years old. 

EMPOWER: Early Signs Monitoring to Prevent Relapse and PrOmote Wellbeing, Engagement and Recovery

Addressing priority 2: Joint research through NIHR and the Australian National Health and Medical Research Council published

Relapse in schizophrenia is a major cause of distress and disability among patients and their families. Teams based in the UK and Australia are working together to build an intervention that refines existing smartphone technology for the monitoring of early warning signs. They will assess the acceptability of this to service users, carers and health professionals and look at the feasibility of a larger scale trial of its acceptability and safety.

Training to recognise the early signs of recurrence in schizophrenia

Addressing priority 2:  Cochrane Review was published in February 2013. It looked at all previous evaluations of how effective early warning signs interventions are and what kind of future research we need in this area.

REMEDY: Randomised Evaluation of Management of sExual Dysfunction

Addressing priority 4: NIHR research published.

A number of drugs improve the mental health of people with psychosis; these are called 'antipsychotic' drugs. Up to a half of people who take them experience sexual side effects including reduced desire for and pleasure from sex. These side effects lead some to stop taking their medication making a relapse more likely. This study will compare the effects of switching a person's medication to an equivalent dose of an alternative antipsychotic drug that is believed to result in fewer sexual side effects. This study started in May 2018 and is due to end in January 2021.

Strategies for managing sexual dysfunction induced by antidepressant medication

Addressing priority 4: A Cochrane Review was published in May 2013. It looked at the results of previous studies around this relatively common side effect of antidepressant medication to find out what management strategies are effective and what the adverse effects and acceptability of them are.

Management of sexual dysfunction due to antipsychotic drug therapy

Addressing priority 4: A Cochrane Review was published in November 2012. It pulled together the results of previous studies looking at the effects of different treatment options.

STEPWISE: Structured lifestyle Education for People WIth Schizophrenia

Addressing priority 10: NIHR research published.

Obesity and problems with weight are two to three times more common in people with schizophrenia. This project created a lifestyle education programme (based on an existing one for Diabetes around diet and physical activity) and evaluated how it could support weight loss in around 5,000 adults, within 10 mental health trusts across the UK. Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective.  Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia.

REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with Severe Mental Illness (SMI)

Addressing priority 10: NIHR research in progress

This project aims to understand which ways of helping service users to manage weight gain are most likely to work in various circumstances.