Collaborative care program for patients with treatment resistant schizophrenia.

Over the past decades, several effective interventions have been developed for
the treatment of patients with TRS, but it is uncertain whether it
is possible to offer this integrated in practice to offer these available
interventions in an integrated manner in clinical practice. To treat patients
with TRS according existing guidelines (in medical
psychiatric and psychosocial field) we introduce a collaborative care program
for patients with TRS (CCP for TRS).

The CCP for TRS is a structured treatment program for patients with TRS that
will be integrated in Early Psychosis Intervention Teams (EPIT)
and Flexible Assertive Community treatment (FACT). The program is based on the
principles of collaborative care. Similar
programs for patients with bipolar disorder or a personality disorder who are
treated in Dutch FACT teams showed improvements
in symptoms, quality of life and functioning. The CCP for TRS consists of:
optimal clozapine treatment, lifestyle interventions, a
peergroup and work with informal caregivers. The program focuses on promoting
empowerment and recovery of patients. Also, effective
coordination and continuity of care get special attention in this program.

CCP for TRS will be investigated in a quasi-experimental study with the
following outcome measures: functioning, psychotic symptons, quality of life,
recovery, the degree of shared decision making, patient self-management and
somatic co- morbidity. We also
investigate the patients' experiences and satisfaction with the CCP for TRS.

- Identifying phenomena and relationships/patterns through in-depth study of a
limited number of cases and get insight in the impact of CCP for TRS on
functioning, psychotic symptoms, quality of life, recovery, self-management,
shared decision-making and somatic co-morbidity.
- Get insight into experiences of patients and caregivers with CCP for TRS and
identify elements that contribute to satisfaction

Quasi-experimental research

Collaborative care program for patïents with treatment resistant schizophrenia

For the intervention study patients are required to visit their own mental
health organization 5 times for the data collection. Usually each visit will
take about 60 to 75 minutes, but if desired by the patient this could also be 2
visits. If necessary, this meeting can even take place at the patient's
residence. At the end of the study patients and caregivers are asked to
participate in a focus groupinterview, which takes about 90 minutes.