In this episode of the JCP Podcast, Dr. Ben Everett speaks with Dr. Nina Schooler, a social psychologist whose career in psychiatric research spans more than six decades. Dr. Schooler began her work at the National Institute of Mental Health's Psychopharmacology Service Center in the early 1960s and has since contributed to landmark studies on antipsychotic treatment, maintenance therapy, tardive dyskinesia, long-acting injectables, negative symptoms, and coordinated specialty care for first-episode psychosis.
As the field increasingly looks toward a paradigm of meaningful functional recovery that goes beyond symptom control, this conversation traces how today's clinical standards, from dose-reduction strategies to the RAISE early-intervention model, emerged from decades of trial design, unexpected findings, and hard-won methodological lessons.
🎯 KEY EPISODE HIGHLIGHTS:
🔍 THE ACCIDENTAL DISCOVERY IN THE FIRST PLACEBO STUDY [12:30]
“the patients who'd been treated with placebo seemed in some ways to be doing better than the patients who had been treated with drug.”
A counterintuitive early finding shows how unblinding and differential attention, not the drug itself, can distort perceived treatment effects in psychiatric trials.
🚧 WHY THE SICKEST PATIENTS ARE MISSING FROM NEGATIVE SYMPTOM TRIALS [1:04:00]
“the patients we most want to include will not be included in the trial because participating in a clinical trial requires effort”
A structural recruitment paradox helps explain why decades of negative symptom trials have struggled to enroll the patients most affected by the condition.
🤝 SCHIZOPHRENIA CARE AS “A TEAM SPORT” [1:19:30]
“My sense of schizophrenia as a treatment target is that it's a team sport, and that it requires a team of people to engage with patients offering a range of treatments for which I see medication as the absolutely essential platform on which other things, can indeed build.”
After six decades in the field, this framing captures why no single intervention, medication or psychosocial, succeeds alone in treating schizophrenia.
CHAPTERS:
0:00 – Introduction: Six Decades of Schizophrenia Research
2:30 – Joining NIMH's Psychopharmacology Service Center in the 1960s
9:00 – Shifting Terminology and the Boundaries of a Schizophrenia Diagnosis
11:30 – A Social Psychologist's Lens on Early Treatment Outcomes
16:00 – Open Questions on Lifelong Treatment and Parallel VA Research
18:30 – The Hogarty-Goldberg Studies and the Two-by-Two Trial Design
27:30 – Expressed Emotion and the Camberwell Family Interview
32:30 – Controlled Trials Versus Real-World Adherence
34:00 – Tardive Dyskinesia and the Push to Lower Antipsychotic Doses
36:30 – Designing the Treatment Strategies in Schizophrenia Study
40:30 – Results: Medication's Value and a Young, Family-Involved Cohort
45:00 – Long-Acting Injectables: Adherence Myths and the PROactive Study
51:30 – Research Diagnostic Criteria for Tardive Dyskinesia and the AIMS Scale
56:30 – Negative Symptoms, Cognition, and the Risperidone Question
1:02:30 – The FDA Workshop and Consent Challenges in the CONSIST Study
1:06:00 – Digital Interventions, EMA, and Smartphone-Based Treatment
1:09:30 – Designing RAISE: A Cluster-Randomized Approach to First-Episode Care
1:15:30 – RAISE Results and the Challenge of Personalized, Team-Based Care
1:21:00 – From RAISE to SAMHSA: Scaling Coordinated Specialty Care
1:25:30 – Has RAISE Changed Community Practice?
1:28:00 – Toward Meaningful Functional Recovery: What Must Change Next
LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep23-six-decades-schizophrenia-care-nina-schooler/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. Nina Schooler – LinkedIn
https://www.linkedin.com/in/nina-schooler-11022870/
NIMH – Recovery After an Initial Schizophrenia Episode (RAISE)
https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise
NIMH overview of the RAISE initiative and coordinated specialty care model discussed at length in this episode.
SAMHSA – Early Serious Mental Illness Treatment Locator
https://www.samhsa.gov/find-help/locators/esmi
Locator for coordinated specialty care programs, funded through the SAMHSA block grants described in this episode.
#Schizophrenia #TardiveDyskinesia #LongActingInjectables #FirstEpisodePsychosis #Psychopharmacology
