Franca Centorrino, MD

Dr. Centorrino’s Psychopharmacology Research Program was founded in 1992 to study the impact of psychotropic medications on patients who have schizophrenia or bipolar disorder, including newer treatment approaches and the management of their side effects.

Dr. Centorrino’s naturalistic studies arise from clinical practice in McLean’s Division of Psychotic Disorders. She explores the population-wide, long-term, real world application of psychiatric medications, comparing treatment outcomes and cost effectiveness. Her research has demonstrated that combining medications is common and can result in increased effectiveness and reduced side effects (though in some patients can lead to increased side effects). These findings help promote the individualized tailoring of medication to improve patient care and outcomes.

In addition, Dr. Centorrino studies the adverse side effects of antipsychotic medications in some patients, including monitoring for metabolic syndrome characterized by weight gain and cardiovascular complications. She has shown that the division’s wellness program for people taking psychotropic medications can often lead to healthier behaviors and lifestyle changes.

Criteria for psychiatric hospitalization have undergone marked changes. Efforts to limit length of hospitalization risk greater morbidity at discharge and increased need for appropriate aftercare. Accordingly, Dr. Centorrino evaluated factors associated with length of psychiatric hospitalization and aftercare types. Notable factors associated with longer hospitalization included highly supervised aftercare, diagnosis of schizophrenia or schizoaffective disorders, longer illnesses, higher antipsychotic doses and more complex drug-treatments at discharge, lower Global Assessment of Functioning status, unemployment, being unmarried, as well as public vs. private insurance. Higher structured aftercare was associated with younger age, fewer years ill, and private insurance, but varied little by diagnosis and was unrelated to ethnicity. Public insurance was associated notably with being unemployed, unmarried, less functional, having a chronic psychotic disorder for more years, and lack of structured aftercare. Illness severity and functional impairment may modulate efforts to limit psychiatric hospitalization.

Dr. Centorrino evaluated prevalence and risk factors for metabolic syndrome in severely or chronically ill inpatients treated with antipsychotics, with or without other psychotropic drugs. With prior antipsychotic treatment, prevalence of metabolic syndrome was 30%. The syndrome was strongly associated with being overweight, older age, longer treatment exposure, schizoaffective diagnosis, more illness episodes or hospitalizations, polytherapy, and higher total daily chlorpromazine-equivalent doses, but not gender. The risk was surprisingly high in young persons and after brief treatment exposure. Psychotropic polytherapy increased the risk.

Treatments given to patients with primary psychotic disorders include mood stabilizers (MSs) combined with other psychotropics, despite the limited evidence of efficacy, safety, and lack of regulatory approval. Dr. Centorrino found the use of MSs extended the duration of hospitalization by an average of 18%, while Clinical Global Impression ratings improved by 55% and adverse-effects risk was lower by 22%. MSs, usually in combination with antipsychotics, were used increasingly for inpatients over the past decade, including for patients with primary psychotic disorders. The effectiveness and safety of this practice remain to be evaluated adequately.