Evaluating outcomes of treatments for persons with psychotic disorders

Advances in the neurosciences, concerns about cost containment, and a growing consumer advocacy movement are creating new hopes and challenges for the development of more effective and cost-effective treatments for persons with psychotic disorders. Using the development of new antipsychotic agents for the treatment of schizophrenia as a prototype, this article examines the assessment of outcomes of treatments for these patients. Psychotic disorders exert a broad range of negative effects on patients' lives. This requires a broad view of outcomes to assess the relative effectiveness of alternative pharmacotherapies. The outcomes of interest cover the clinical, rehabilitative, humanitarian, and public welfare domains. Most of our knowledge about the efficacy of antipsychotic agents focuses on improvements in and prevention of positive symptoms of schizophrenia. However, better antipsychotic medications must show advantages above and beyond symptom suppression. We need to know not only whether alternative medications offer advantages in these other dimensions of outcome, but also how they interact with psychosocial treatments to enhance outcomes, how effective they are with patients in usual practices settings, and how cost-effective they are relative to other treatments. A research agenda for evaluating these impacts must include longer term outcome studies that evaluate the wider range of outcomes of interest to practitioners, patients, families, and payers.