Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagem

描述（由申请人提供）：减少未治疗精神病的持续时间（DUP）是改善首发精神病（FEP）年轻人长期预后的主要目标。美国的“FEP护理标准”侧重于针对早期精神病的体征和症状进行有针对性的提供者教育1，以激励患者转介到FEP服务，然后在主要以临床为基础的环境中启动服务2。加州大学萨克拉门托分校戴维斯分校的早期诊断和预防治疗（EDAPT） FEP专业项目的经验已经确定了降低DUP的两个重要瓶颈，这与其他FEP诊所的文献报道一致。这些是1)通过转诊来源识别精神病症状的延迟，以及2)患者参与专业FEP护理的延迟或中断。在萨克拉门托地区20个站点（学校/大学、急诊室/住院医院、门诊心理健康、初级保健）的综合和已建立的转诊网络的基础上，我们将使用两阶段、集群随机设计来解决患者识别和参与的延迟问题。我们将连续测试两种干预措施对降低DUP的影响，DUP在本RFA中定义为从首次出现精神病症状到参与FEP专业护理的时间。为了解决识别延迟问题，我们将检查标准目标提供者教育加新型技术增强筛查的使用，与单独的标准目标提供者教育相比，测试教育加技术增强筛查将在疾病早期识别更多患者的假设。为了解决参与延迟问题，我们将比较移动社区、远程精神病学增强参与团队与基于诊所的标准治疗程序的使用，包括接受、参与和开始治疗，以检验移动方法促进更早、更稳定的参与，从而减少DUP的假设。提出的工作将提供新的具体的循证实践，以减少DUP，并通过对首发精神病患者的专业护理来改善结果。

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.