Innovative center looks at the big picture
Built in the '60s, Arnold Hall sits on a hill overlooking the lake at the San Antonio State Hospital (SASH). The building has become one of the most innovative treatment facilities for psychotic disorders in the country.
Arnold Hall houses one of the nation's most efficient clinical drug testing. Its staff works with the Health Science Center and the Audie Murphy Division, South Texas Veterans Health Care System, taking a "whole person" philosophy that is producing uniquely positive results.
The team has learned from experience that no drug alone can integrate a person with schizophrenia into society, just as "talking therapy" can't help without something to stop the florid psychotic symptoms.
In 1990, the state hospital had already been the site for new medication trials for more than a decade. That year, the 16-bed clinical research unit opened, thanks to funding from the Texas Legislature. In 1994, it moved to Arnold Hall.
"We had been working to establish the unit since 1982," says Alexander L. Miller, MD, professor of psychiatry at the Health Science Center and the state hospital's founding director of clinical research. "We had tremendous support from community groups, from Bexar County legislators such as Rep. Ciro Rodriguez, and from community psychiatrists including Robert Jimenez and Victor Weiss."
Today, the state still maintains the facility and specific research efforts are funded by the National Institute of Mental Health, the Hogg Foundation for Mental Health, the South Texas Health Research Center and other groups.
Larry Ereshefsky, PharmD, professor of pharmacology at the Health Science Center, organized the state hospital's first tests of clozapine in the late 1980s. The San Antonio group was one of the 16 centers in the country to first test clozapine, even before the hospital's research unit was formalized. "The findings here, like those worldwide, were that the drug offered dramatic improvement to schizophrenics," Dr. Miller says.
"The development of clozapine opened up a whole new world of possibilities for schizophrenics and for their caregivers," Miller says. "It was the first drug in years to allow us to make a quantum leap in treatment. It set off a drug race similar to the space race that followed the Russian launching of Sputnik and later the first cosmonaut."
Following closely on the heels of clozapine's approval, the Health Science Center and the state hospital began participating in national trials on a dozen more similar drugs. In the early 1990s, Health Science Center faculty were conducting as many as 10 drug trials at once. Today, six drug studies are ongoing.
The makers of three drugs tested by the San Antonio team - sertindole, olanzapine and seroquel -- have applied to the Food and Drug Administration for approval and those may be available by next year.
"The advent of antipsychotic drugs has allowed patients to be maintained in less restrictive settings," says Dr. Miller. "Treatment has changed from institutionalization to staying in the community with brief hospitalizations if necessary."
Hospitalization is the big cost factor. "Some years ago, public opinion and governmental budget constraints pushed for getting patients out of the hospital," says Dr. Miller. "The San Antonio State Hospital, for example, has reduced its patient population from about 2,000 in the 1970s to about 400 patients today.
"When patients leave the hospital, the burden then falls on the families and the community agencies, which are still woefully underfunded," he says.
Treatment of schizophrenia has made a quantum leap with the advent of the new antipsychotics and now the long-term effects are being closely watched. "In addition to refining new medications, we must continue to address the whole range of human activities and help people with schizophrenia to handle their environment as well as try to help the environment -- their families and society -- to handle them," Dr. Miller says.
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