Psychiatric Treatment and Violence Risk Management

描述(由申请者提供)：拟议的独立科学家奖为Jeffrey Swanson博士提供五年的工资支持，以开发和实施一项综合研究计划，该计划以他以前的工作为基础，但纳入了新的视角和方法来解决几个相关主题：暴力和精神障碍的流行病学、精神分裂症治疗的有效性、严重精神疾病(SMI)的决策能力丧失，以及精神病学先行指令的实施。首先，他将对几个数据集进行系统的比较分析，以更好地了解影响社区中部分严重精神疾病患者的暴力行为的多方面问题。其次，他将使用NIMH临床抗精神病药物干预有效性试验(CATIE)的新数据来检查和比较特定抗精神病药物治疗对精神分裂症患者暴力风险的影响。第三，他将使用CATIE的数据来调查，对于一些患有SMI的人来说，对疾病和决策能力丧失的不稳定洞察力可能会在多大程度上限制获得有效治疗的机会，否则这些治疗可能会阻止暴力行为。第四，斯旺森博士的研究将利用1-R01-MH63949-01(有效执行精神病学先行指令)的数据，探讨一种新的法律文书--精神病学先行指令(PADS)--对有决策能力丧失风险的SMI患者的暴力和相关后果的潜在影响。作为其职业发展计划的一部分，斯旺森博士还提议与几个学科的专家合作，开发暴力、精神障碍和治疗有效性的理论模型。这些专家将带来新的观点和方法，将深化和拓宽他的智力努力：苏·埃斯特罗夫博士在医学人类学和社会医学；约翰·费尔班克博士在医疗心理学、创伤和药物滥用干预方面；玛莎·沙姆韦博士在健康心理学、精神健康治疗结果和偏好测量方面；威廉·温斯莱德博士在医学哲学、伦理学和法律精神病学方面。拟议的奖项将使斯旺森博士能够将他的研究生涯集中在他最感兴趣和有潜力在未来做出重大贡献的领域；实施一个综合的学术计划，综合他以前工作的发现，并以新的方式解决重要的、相互关联的问题。通过开发额外的R01资金项目，这项工作最终将导致更有针对性的干预措施和政策，以降低暴力风险，提高SMI患者的生活质量。

DESCRIPTION (provided by applicant): The proposed Independent Scientist Award provides five years of salary support for Dr. Jeffrey Swanson to develop and carry out an integrated program of research, building on his previous work but incorporating new perspectives and methods to address several related topics: epidemiology of violence and psychiatric disorder, schizophrenia treatment effectiveness, decisional incapacity in severe mental illness (SMI), and implementation of psychiatric advance directives. First, he will conduct systematic comparative analysis of several datasets to provide a better understanding of the multifaceted problem of violent behavior that affects a proportion of persons with severe mental illness in the community. Second, he will use new data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) to examine and compare the effects of treatment with specific antipsychotic medications on violence risk in persons with schizophrenia. Third, he will use CATIE data to investigate the extent to which, for some persons with SMI, fluctuating insight into illness and decisional incapacity may limit access to effective treatment that might otherwise prevent violent behavior. Fourth, Dr. Swanson's research will address the potential impact of a new legal instrument--psychiatric advance directives (PADs)--on violence and related outcomes for persons with SMI at risk of decisional incapacity, using data from 1-R01-MH63949-01 (Effectively Implementing Psychiatric Advance Directives.) As part of his career development plan, Dr. Swanson also proposes to work with experts in several disciplines to develop a theoretical model of violence, mental disorder, and treatment effectiveness. These experts will bring novel viewpoints and methods that will both deepen and broaden his intellectual endeavors: Dr. Sue Estroff in medical anthropology and social medicine; Dr. John Fairbank in medical psychology, trauma and substance abuse interventions; Dr. Martha Shumway in health psychology, mental health treatment outcomes and preferences measurement; and Dr. William Winslade in medical philosophy, ethics, and legal psychiatry. The proposed award will enable Dr. Swanson to concentrate his research career in the areas of his greatest interest and potential to make a significant contribution in the future; to conduct an integrated program of scholarship, synthesizing findings from his previous work and addressing important, inter-connected questions in new ways. Through additional R01-fundable projects to be developed, this work will lead eventually to better-targeted interventions and policies for reducing violence risk and improving quality of life for persons with SMI.