Psychosis: Early Detection, Intervention and Prevention

描述（由申请人提供）：本申请的主要目的是对专门为前驱精神病性障碍开发的专门精神卫生服务提供系统进行随机对照临床试验。这是一种家庭援助的自信社区治疗（FACT）。这项拟议的研究将是一个更大的计划，波特兰识别和早期转诊（PIER）的一部分，在基金会和中心的精神卫生中心的赞助下，已经建立了一个以人口为基础的系统，早期发现大波特兰，缅因州。 过去和现在的努力教育和培训了整个社区以及所有卫生、教育和其他专业人员，结果是转诊的频率达到了预期水平。主要的策略是在精神病发作之前和发作过程中进行早期干预，以阻止精神病症状和功能障碍的发展。测试治疗是心理教育多家庭小组和自信的社区治疗的专业组合。在试点研究中，FACT导致转化为精神病的比率非常低，参与和保留治疗的比率非常高，从而减轻了家庭和社区的负担。治疗的目标是预防精神病和残疾。 本研究将通过实验评估这种新型精神卫生服务的临床效果。其他领域的结果包括认知功能障碍和功能障碍。该项目将支持EDIPFACT团队的临床工作人员的能力：a。在大波特兰社区中通过全科医生、指导顾问、精神健康专业人员和普通公众促进前驱障碍的检测; B.准确地评估处于精神病高风险的个体; c.使用标准化方法可靠地提供基于证据的心理社会和（如有指征）药理治疗包。该研究将在一项随机对照试验中测试该系统确定的96名12至35岁受试者的症状和功能治疗结果。它将允许分析导致精神病的关键社会因素及其与治疗条件和彼此的相互作用。

DESCRIPTION (provided by applicant): The primary aim of this application is to conduct a randomized, controlled clinical trial of a specialized mental health service delivery system specifically developed for prodromal psychotic disorders. The intervention is Family-aided Assertive Community Treatment (FACT). The proposed study will be part of a larger program, Portland Identification and Early Referral (PIER), under foundation and Center for Mental Health Center sponsorship, that has established a population-based system of early detection for Greater Portland, Maine. Previous and present effort has educated and trained the community-at-large and all health, education and other professionals, with the result that referrals are occurring at the expected frequency. The principle strategy is to intervene early, prior to onset, in the course of the onset of psychotic disorders to arrest the development of psychotic symptoms and functional disability. The test treatment is a specialized combination of psychoeducational multifamily group and assertive community treatment. In pilot studies FACT has led to very low rates of conversion to psychosis and very high rates of engagement and retention in treatment, thereby decreasing the burden on the family and the community. The goal of the treatment is prevention of psychosis and disability. This study will assess experimentally the clinical effectiveness of this new type of mental health service. Other domains of outcome include cognitive dysfunction and functional disability. The project will support an EDIPFACT team of clinical staff with the ability to: a. foster detection of prodromal disorders in the Greater Portland community by general practitioners, guidance counselors, mental health professionals and the general public; b. accurately assess individuals at high risk for psychosis; c. reliably deliver an evidence-based psychosocial and, if indicated, pharmacological treatment package using standardized methodology. The research study will test, in a randomized controlled trial, the symptomatic and functional outcome of treatment in 96 subjects ages 12 to 35 identified by that system. It will allow the analysis of key social factors contributing to psychosis and their interaction with the treatment conditions and each other.