Psychosis and Co-morbid Substance Misuse

Established: April 2006, 1st meeting July 2006

Convenor (Chair): Professor Thomas Barnes, Professor of Clinical Psychiatry, Imperial College London. (contact details: t.r.barnes@imperial.ac.uk or the Departmental Administrator, Sheila Mackenzie e-mail: s.mckenzie@imperial.ac.uk)

Members:
Prof. Thomas Barnes (Psychiatry) Imperial College London (Convenor); Dr. Tim Weaver (Social Science) Imperial College London; Dr. Sonia Johnson (Psychiatry) Royal Free & University College Medical School, London; Prof. Stefan Priebe (Psychiatry) Queen Mary, University of London; Dr. Hermine Graham (Psychology) School of Psychology, University of Birmingham; Prof. Christine Barrowclough (Psychiatry) University of Manchester; Prof. Tom Craig (Psychiatry) Institute of Psychiatry, Kings College London; Dr. Michael Farrell (Psychiatry) Institute of Psychiatry, Kings College London; Dr. Ann Lingford-Hughes (Psychiatry) University of Bristol; Prof. Swaran Singh (Psychiatry) University of Warwick; Rogan Wolf (Service User Representative) Westminster User Groups;

Remit and Aims:
Drug misuse amongst psychotic patients is prevalent, associated with poor treatment outcomes and (e.g. with respect to cannabis) may increase the risk of developing psychotic symptoms in susceptible individuals.

The reasons for the high prevalence of drug misuse in psychotic populations are poorly understood and evidence about how to intervene to reduce drug use is limited. The management of co-morbidity is therefore a key development issue for mental health services

The aim of the research group is develop and evaluate new treatment and service delivery interventions for comordid psychosis and drug misuse. This intervention research will be informed by parallel investigation into the factors that generate and sustain high levels of drug use in the target population.

UK policy is to support mainstream mental health services to manage co-morbidity, but few co-morbid patients receive specialist substance misuse interventions. Brief, practical interventions that can be generalisable to mainstream services (particularly amongst first episode populations) are urgently required. However, for services to effectively target, reduce or stop drug misuse, research that identifies the factors that sustain drug misuse in the context of psychotic disorder is needed.

Current Status & Future Plans:
Psychosis and co-morbid drug misuse is a major public health issue and a high priority for funders. The proposed group brings together independent investigators with excellent track records in securing funding, who are active in the field and have relevant in expertise in epidemiology, health service evaluation, neurobiology, health behaviour, qualitative research and the evaluation of complex interventions. The group will provide an otherwise absent mechanism for multi-disciplinary collaboration; it will add value to current MHRN projects (e.g. PsyGrid) and greatly increase the potential for real progress in a challenging field where improved outcomes for clients have often proved to be elusive

6 month Progress report (Dec 06): A more inclusive list of members and specific members of the research group have been invited to lead on protocol development for studies in three areas. 1. Treatment interventions; 2. Case management and 3. Social aetiology.

Subsequently, members of the group have been involved in grant applications on:
1) psychosis and comorbid substance use to the Research for Patient Benefit (RfPB) and SDO funding schemes. One of the RfPB bids supported by the research group, a feasibility study of a dual diagnosis/first-episode intervention, has been short-listed. A further submission exploring the impact of clozapine on comorbid substance use in schizophrenia is being developed for the RfPB scheme early next year.
2) related studies have been included in at least one short-listed application for an NIHR Programme grant in Applied Research.

A second meeting is planned for the end of January 2007, to review the progress of the applications submitted and consider further collaborative proposals for 2007.

12 month progress report (July 07): Over the last six months, members of the group have been involved in several collaborative study proposals, including a submission to the NIHR Research for Patient Benefit scheme for a pilot study to examine the therapeutic benefits of clozapine in patients with schizophrenia and comorbid substance misuse and, in partnership with the Physical and Metabolic Consequences of Severe Mental Illness MHRN research group, a submission to the HTA for a randomised controlled trial of a bespoke smoking cessation service for people with severe mental illnesses.

A meeting of the group is planned for Autumn 2007 to consider the development of a further collaborative grant proposal, focusing on drug misuse behaviour in people with psychosis.

Link to progress report (March 08)