Leslie Citrome, M.D., M.P.H., Director

The Clinical Research and Evaluation Facility (CREF) advances modern knowledge in the evaluation and treatment of some of the most vexing clinical problems facing the mental health field. Along with its important ongoing work in the areas of treatment-refractory schizophrenia and novel therapeutic approaches, the CREF is also a leader in the study of aggression and violence in persons suffering from serious and severe mental illness.

Operated as a partnership between Rockland Psychiatric Center and NKI, the CREF consists of two inpatient wards (with 12 beds each). One is specially equipped to permit the study of patients who have problems with aggression. The research focuses on the biological and psychological aspects of violent behavior in persons with mental illness. Research projects include the areas of psychopharmacology, brain imaging, genetics and gene expression, and cognition. Patients are primarily recruited from Rockland Psychiatric Center.

The requests for evaluation of individual violent patients are generally initiated by the treatment team of the inpatient unit where the patient resides. The evaluation results in a diagnosis with recommendations for clinical management. Patients transferred for evaluation may be approached for their consent to participate in research if they meet the eligibility criteria for an ongoing project. As always, refusal to consent will not affect the patient's clinical care. Once the patient's evaluation is complete, he/she will be transferred back to the referring unit, or discharged as appropriate.

The other unit focuses on, but is not limited to, the symptoms and sequelae of illnesses such as schizophrenia, mood disorders, dementia with psychiatric complications, co-morbid substance abuse disorders and psychoneurological problems such as tardive dyskinesia and other movement disorders. It utilizes technological resources such as neuroimaging, electrophysiology, neurochemistry, analytic psychopharmacology and advanced neurodiagnostics. Research and evaluation activities include a structured interview for diagnostic purposes, psychopharmacology, psychiatric rehabilitation, and neuropsychological assessments. Clinical trials of new and novel medications, as well as new approaches using conventional medications are studied.

Representative publications in the scientific literature include:

1. Volavka J, Czobor P, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, Cooper TB, Chakos M, Lieberman JA. Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am J Psychiatry. 2002 Feb;159(2):255-62.
2. Citrome L, Krakowski M, Greenberg WM, Andrade E, Volavka J. Antiaggressive effect of quetiapine in a patient with schizoaffective disorder. J Clin Psychiatry. 2001 Nov;62(11):901.
3. Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, Lindenmayer JP, Citrome L, McEvoy J, Kunz M, Chakos M, Cooper TB, Horowitz TL, Lieberman JA. Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder. Am J Psychiatry. 2002 Jun;159(6):1018-28.
4. Richardson MA, Bevans ML, Read LL, Chao HM, Clelland JD, Suckow RF, Maher TJ, Citrome L. Efficacy of the branched-chain amino acids in the treatment of tardive dyskinesia in men. Am J Psychiatry. 2003 Jun;160(6):1117-24.
5. Nolan KA, Czobor P, Roy BB, Platt MM, Shope CB, Citrome LL, Volavka J. Characteristics of assaultive behavior among psychiatric inpatients. Psychiatr Serv. 2003 Jul;54(7):1012-6.
6. Citrome L, Tremeau F, Wynn PS, Roy B, Dinakar H. A study of the safety, efficacy, and tolerability of switching from the standard delayed release preparation of divalproex sodium to the extended release formulation in patients with schizophrenia. J Clin Psychopharmacol. 2004 Jun;24(3):255-9.
7. 7. Volavka J, Czobor P, Nolan K, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, Cooper TB, Lieberman JA. Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. J Clin Psychopharmacol. 2004 Apr;24(2):225-8.
8. Citrome L, Volavka J, Czobor P, Sheitman B, Lindenmayer JP, McEvoy J, Cooper TB, Chakos M, Lieberman JA. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatr Serv. 2001 Nov;52(11):1510-4.
9. Bilder RM, Volavka J, Czobor P, Malhotra AK, Kennedy JL, Ni X, Goldman RS, Hoptman MJ, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, Kunz M, Chakos M, Cooper TB, Lieberman JA. Neurocognitive correlates of the COMT Val(158)Met polymorphism in chronic schizophrenia. Biol Psychiatry. 2002 Oct 1;52(7):701-7.

For further information about CREF, contact Dr. Citrome at