Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagem

描述(由申请人提供)：缩短未治疗精神病(DUP)的持续时间是改善首发精神病(FEP)年轻人长期结果的主要目标。美国国内的“FEP护理标准”侧重于针对早期精神病症状和体征的针对性提供者教育1，以促使患者转诊至FEP服务，然后在主要以临床为基础的环境中启动服务2.萨克拉门托加州大学戴维斯分校的早期诊断和预防性治疗(Edapt)FEP专科项目的经验发现了减少DUP的两个重要瓶颈，这与其他FEP诊所的文献报告一致。这些是1)通过转诊来源识别精神病症状的延迟，以及2)患者参与专科FEP护理的延迟或中断。在萨克拉门托地区20个地点(学校/大学、急诊室/住院医院、门诊精神卫生、初级保健)的全面和成熟的转诊网络的基础上，我们将使用两阶段、群组随机设计来解决患者识别和参与方面的延误问题。我们将连续测试两种减少DUP的干预措施的影响，在本RFA中，DUP定义为从首次出现精神症状到参与FEP专科护理的时间。为了解决识别延迟，我们将检查标准目标提供者教育加上新技术增强筛查的使用情况，与仅使用标准目标提供者教育相比，测试教育加上技术增强筛查将识别更多患者的假设，更早发现他们的疾病。为了解决参与延迟，我们将比较基于社区的移动、心灵感应增强的参与团队的使用与基于诊所的标准程序的摄取、参与和开始治疗，以检验移动方法有助于更早和更稳定的参与，从而减少DUP的假设。拟议的工作将提供新的具体的循证做法，通过对首发精神病患者的专门护理，减少DUP并改善结果。

DESCRIPTION (provided by applicant): Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term outcomes in young people with a first episode of psychosis (FEP). The "standard of FEP care" within the US focuses on targeted provider education1 regarding signs and symptoms of early psychosis to motivate patient referrals to FEP services, followed by initiation of services within largely clinic-based settings 2. Experience at the Early Diagnosis and Preventive Treatment (EDAPT) FEP specialty program at U.C. Davis in Sacramento has identified two important bottlenecks to reducing DUP, consistent with reports in the literature from other FEP clinics. These are 1) delays in the identification of psychotic symptoms by referral sources, and 2) delays or disruptions of patient engagement in specialty FEP care. Building upon a comprehensive and established referral network of 20 sites across the Sacramento area (schools/universities, ER/inpatient hospitals, outpatient mental health, primary care), we will address delays in patient identification and engagement using a two- phase, cluster randomized design. We will consecutively test the impact of two interventions to reduce DUP, defined in this RFA as time from first onset of psychotic symptoms to engagement in FEP specialty care. To address identification delays, we will examine the use of standard targeted provider education plus novel technology-enhanced screening compared to standard targeted provider education alone, testing the hypothesis that the education plus technology-enhanced screening will identify more patients, earlier in their illness. To address engagement delays, we will compare the use of a mobile community-based, telepsychiatry- enhanced engagement team to standard clinic-based procedures for intake, engagement and initiation of treatment, to test the hypothesis that the mobile approach facilitates earlier and more stable engagement, thereby reducing DUP. The proposed work will provide new specific evidence-based practices for reducing DUP and improving outcomes through specialty care of individuals with a first episode of psychosis.