Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial.
Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial.
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DOI：
10.1093/schizbullopen/sgab057
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Keshavan MS
中科院分区：
文献类型：
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作者：
Srihari VH;Ferrara M;Li F;Kline E;Gülöksüz S;Pollard JM;Cahill JD;Mathis WS;Yoviene Sykes L;Walsh BC;McDermott G;Seidman LJ;Gueorguieva R;Woods SW;Tek C;Keshavan MS
未经治疗的精神病的持续时间（DUP）仍然长得令人无法接受，限制了护理的有效性。确定早期检测活动（“思维导图”）是否可以减少美国社区环境中的DUP。在这项非随机对照试验中，Mindmap针对2015年至2019年的一项专业首次发作服务或FES（STEP，大纽黑文）的集水区，而常规检测工作继续在对照FES（PREP，大波士顿）进行。Mindmap通过大众和社交媒体消息传递、专业外展和详细说明以及快速推荐登记来针对不同的延迟来源。两种FES均招募了16-35岁且精神病发作≤3年的患者。结局指标包括DUP-总（精神病发作至FES入组）、DUP-需求（精神病发作至首次抗精神病药物治疗）和DUP-供应（首次抗精神病药物治疗至FES入组）。在STEP招募了171名受试者，在PREP招募了75名受试者。思维导图与STEP的推荐数量和参与效率的增加有关。竞选前的DUP（2014-2015）相当，而Mindmap与STEP的DUP减少相关，但与PREP无关。DUP-Total在第一和第二四分位数均显着下降（每个竞选年分别减少11.5和58.5天）。DUP-需求和DUP-供应仅在第三四分位数下降（每个运动年分别减少46.3和70.3天）。PREP时所有四分位数均未检测到降低，但研究中心之间的比较不显著。这是美国社区DUP减少的第一个受控演示，可以为未来在不同环境中的早期检测工作提供信息。
Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign (“Mindmap”) can reduce DUP in a US community setting. In this nonrandomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach & detailing, and rapid enrollment of referrals. Both FES recruited 16–35 years old with psychosis onset ≤3 years. Outcome measures included DUP-Total (onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication), and DUP-Supply (first antipsychotic medication to FES enrollment). 171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number of referrals and in efficiency of engagement at STEP. Pre-campaign DUP (2014–2015) was equivalent, while Mindmap was associated with DUP reductions at STEP but not PREP. DUP-Total fell significantly in both the first and the second quartile (11.5 and 58.5 days reduction per campaign year, respectively). DUP-Demand and DUP-Supply fell in the third quartiles only (46.3 and 70.3 days reduction per campaign year, respectively). No reductions were detectable across all quartiles at PREP, but between site comparisons were not significant. This is the first controlled demonstration of community DUP reduction in the US, and can inform future early detection efforts across diverse settings.