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障碍开发的专业精神卫生服务提供系统进行随机对照临床试验。干预是家庭辅助自信社区治疗（FACT）。在基金会和精神健康中心的赞助下，这项拟议中的研究将成为波特兰识别和早期转诊（PIER）这一更大项目的一部分，该项目已经在缅因州大波特兰建立了一个以人口为基础的早期检测系统。过去和现在的努力对整个社区以及所有保健、教育和其他专业人员进行了教育和培训，结果是以预期的频率进行转诊。主要策略是在精神病发作之前，在精神病发作过程中进行早期干预，以阻止精神病症状和功能残疾的发展。测试治疗是心理教育多家庭小组和自信社区治疗的专门结合。在试点研究中，事实导致转化为精神病的比率非常低，而参与和坚持治疗的比率非常高，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。

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.