Developing Strategies to Reduce DUP in the Age of Social Medial and the Internet

描述(申请人提供)：近年来一个关键的发展是互联网和社交媒体使用率的巨大增长，特别是在年轻人中。我们提议利用互联网和社交媒体开展三个综合性的探索性/发展性项目，旨在缩短未治疗精神病(DUP)的持续时间。在美国，每年大约有10万名青少年和年轻人经历第一次精神病(FEP)。尽管症状严重，功能下降，但在美国，从症状出现到接受适当护理的时间平均为2年。我们正在进行的NIMH资助的精神分裂症发作后康复(RAISE)项目在全美34家诊所进行，涉及404名FEP患者，数据显示未治疗精神病(DUP)的中位数为74周。北美前驱症状纵向研究(NAPLS)显示了一个类似的时期(即2年)，在此期间，出现的减弱症状发展成完全的精神病(前驱期)。因此，对于许多患有新出现的精神障碍的年轻人来说，在开始治疗之前，总的活跃(减弱+完全)症状的时间可能平均为4年；此外，他们的“护理途径”往往不太理想。研究表明，较长的DUP独立预测更多的医院重新入院，更严重的症状和更差的生活质量。拟议项目的结果将提供新的信息，这些信息对于建立互联网/社交媒体的外联和参与手段至关重要，可以利用这些信息来识别和转介具有FEP前驱症状或体征和症状的患者，以便及时进行专门治疗。这些项目将确定具体方法的可接受性和可行性：(1)我们将完善采访，首次记录在每个年轻人的精神病或减轻的精神病症状的演变过程中和回应期间使用互联网和社交媒体的情况。这将提供关键信息，确定潜在的干预点，以及如何在临床研究中利用互联网/社会医学来改善护理路径，并帮助更及时地引导患者接受治疗。(2)我们将在大学生中测试使用电子调查工具的可行性，该工具可以为精神病的早期迹象提供匿名自我评估，并链接到教育网站，并为得分超过指定门槛的人推荐既定的第一集节目。(3)我们还将与纽约市两所顶尖公立和私立高中的学生团队合作，让他们竞争奖项，因为他们开发了有前途的互联网和社交媒体策略，以识别患有精神病或FEP的高危青少年，并将他们与治疗联系起来。学生们还将就该项目的其他方面向我们提供建议。所有这些工作的目的都是为了开发和完善战略，以便在随后的大规模研究中使用，这些研究旨在证明我们有能力通过互联网和社交媒体战略大幅减少美国的DUP。

DESCRIPTION (provided by applicant): A critical development in recent years has been the enormous growth of internet and social media utilization, particularly among young people. We are proposing to conduct three integrated, exploratory/developmental projects utilizing internet and social media directed towards reducing the duration of untreated psychosis (DUP). Approximately 100,000 adolescents and young adults in the U.S. experience a first episode of psychosis (FEP) every year. Despite symptom severity and declines in functioning, the time between symptom onset and receiving appropriate care in the U.S. is on average 2 years. Data from our ongoing NIMH-funded Recovery After an Initial Schizophrenia Episode (RAISE) project, being conducted at 34 clinics across the U.S. involving 404 FEP patients, indicate a median duration of untreated psychosis (DUP) of 74 weeks. The North American Prodrome Longitudinal Study (NAPLS) shows a similar period (i.e., 2 years) during which emerging attenuated symptoms develop into full-blown psychosis (the prodromal period). Thus, for many young people with emerging psychotic disorders, the total period of active (attenuated plus full-blown) symptoms before initiation of treatment may be 4 years on average; furthermore, their "pathways to care" are often less than ideal. Longer DUP has been shown to independently predict more hospital readmissions, greater symptom severity and poorer quality of life. Results from the proposed projects will provide novel information that is critical for establishing internet/social media means of outreach and engagement, which can be leveraged to identify and refer patients with either prodromal (attenuated positive) symptoms or signs and symptoms of FEP for timely, specialized treatment. These projects will establish the acceptability and feasibility of specific approaches: (1) We will refine an interview that is the first to document hw the internet and social media were utilized during, and in response to, the evolution of each young person's psychotic or attenuated psychotic symptoms. This will provide critical information identifying potential points of intervention and how to utilize the internet/social meda in a clinical study to improve pathways to care and help steer patients into treatment in a more timely fashion. (2) We will test the feasibility of using an e-survey instrument with college students, which can provide anonymous self-assessment for early signs of psychosis, with linkages to educational websites and referrals to established first-episode programs for those who score above a specified threshold. (3) We will also work with teams of students at two of the top public and private high schools in New York City to engage them in competing for prizes for developing promising internet and social media strategies to identify youth at high risk of psychosis or with FEP and link them to treatment. The students will also advise us on other aspects of the project. All of this work is designed with the goal of developing and refining strategies to be used in the conduct of subsequent, large-scale studies intended to demonstrate our ability to significantly reduce DUP in the U.S. via internet and social media strategies.