Early Stage Identification and Engagement to Reduce Duration of Untreated Psychosis (EaSIE)

早期识别和参与以减少未经治疗的精神病的持续时间 (EaSIE)

• 批准号: 9457105
• 负责人: Yulia Landa
• 金额: $ 28.34万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-19 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9457105
• 关键词: Adolescence; Adolescent; Adolescent and Young Adult; Adult; Age; Attenuated; Caregivers; Caring; Child; Clinic; Cognitive Therapy; Communication; Communities; Community Health Systems; Community Mental Health Services; Consent; Controlled Study; Detection; Deterioration; Early Diagnosis; Early Intervention; Early identification; Economics; Enrollment; Equipment and supply inventories; Evaluation; Family; Feedback; Goals; Health system; Healthcare; Impairment; Individual; Interview; Knowledge; Maps; Measures; Mental Health; Mental Health Services; Methods; Monitor; Netherlands; Outpatients; Pathway interactions; Patients; Phase; Population; Prevention education; Procedures; Process; Psychotic Disorders; Questionnaires; Recommendation; Recovery; Rehabilitation therapy; Risk; Route; Schizophrenia; Services; Social Development; Societies; Symptoms; Time; TimeLine; Treatment Cost; Treatment outcome; Visual; World Health Organization; Youth; base; cognitive development; cognitive function; disability; education evaluation; emerging adult; experience; first episode psychosis; functional decline; functional restoration; help-seeking behavior; improved; improved outcome; intervention program; medical specialties; mental health center; mental state; prevent; productivity loss; programs; psychiatric disability; psychosocial; psychotic symptoms; public health relevance; reduce symptoms; screening; symptom treatment

PROJECT SUMMARY/ABSTRACT Psychosis typically emerges in late adolescence or early adulthood, during a vital stage in social and cognitive development, which can have a profoundly adverse impact on an individual’s long-term functioning. Numerous studies find a substantial delay between the onset of psychosis and the initiation of specialty treatment for first episode psychosis (FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S. Better detection strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. The onset of psychosis is preceded by a prodromal phase characterized by attenuated psychotic symptoms and decline in functioning. This phase (at-risk mental state: ARMS) is a potential target for strategies aimed at improving outcome by reducing DUP through regular symptom monitoring. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands can reduce DUP in the U.S. setting. The Dutch study found that screening of a consecutive help-seeking population entering mental health services captures significantly more FEP and ARMS cases than clinician referrals from mental health centers. Therefore screening may be an effective strategy for identifying individuals with psychotic symptoms earlier on in the course of their illness. This study will implement and evaluate a systematic screening for psychotic symptoms in community mental health clinics in order to facilitate rapid identification and engagement in treatment of individuals with FEP. Individuals ages 12 to 30 entering child/adolescent and adult community mental health clinics (CMHCs) within Mount Sinai Health System will be screened with the 16-item Version of the Prodromal Questionnaire (PQ-16). Those who screen positive will be assessed by Comprehensive Assessment of at-Risk Mental State (CAARMS) and referred to stage-specific specialty care. Individuals with FEP will be referred to CSC programs: OnTrackNY and PEER. Individuals with ARMS will be monitored and referred to ICanFeelBetter program for ARMS. DUP will be measured for all individuals who meet CAARMS psychosis criteria. We hypothesize that screening for psychotic symptoms in CMHCs will be feasible and acceptable, and that the average DUP of FEP individuals identified with screening will be less than 3 months, the maximum time between onset of psychotic symptoms and engagement in CSC recommended by the World Health Organization. In order to optimize screening and treatment engagement strategies for reducing DUP, we will identify facilitators and barriers to FEP care through in-depth qualitative interviews with patients and caregivers, and by mapping pathways to FEP care. We will also conduct in-depth qualitative interviews with clinicians to explore their experience with the screening and referral process. Findings from this project will inform a fully powered, controlled study to evaluate whether this screening method, compared to traditional referral, leads to more timely identification of FEP cases earlier in the course of illness.

项目概要/摘要 精神病通常出现在青春期末或成年早期，处于社会和认知的重要阶段 发展，这可能对个人的长期功能产生深远的不利影响。很多的 研究发现精神病的发作和首次专业治疗的开始之间有很大的延迟 在美国，发作性精神病 (FEP) 未经治疗的精神病 (DUP) 持续时间通常超过一年 需要更好的检测策略来提高对 FEP 患者的识别并快速参与 他们接受旨在恢复功能的协调专业护理 (CSC)。精神病发作之前 以精神病症状减弱和功能下降为特征的前驱期。这一阶段 （有风险的心理状态：ARMS）是旨在通过减少 DUP 来改善结果的策略的潜在目标 通过定期症状监测。这项研究将调查美国是否成功改编了 荷兰的检测方法可以减少美国环境中的 DUP。荷兰研究发现 对进入心理健康服务的连续寻求帮助的人群进行筛查可以捕获更多信息 FEP 和 ARMS 病例数高于精神卫生中心临床医生转介的病例数。因此，筛查可能是 在病程早期识别患有精神病症状的个体的有效策略。 本研究将实施和评估对社区精神障碍患者精神病症状的系统筛查 健康诊所，以促进快速识别 FEP 患者并参与治疗。 年龄在 12 至 30 岁之间进入儿童/青少年和成人社区心理健康诊所 (CMHC) 的个人 西奈山卫生系统将使用包含 16 项的前驱问卷 (PQ-16) 进行筛查。 筛查结果呈阳性的人将接受高危精神状态综合评估 (CAARMS) 并称为特定阶段的专业护理。具有 FEP 的个人将被转介至 CSC 计划：OnTrackNY 和 PEER。患有 ARMS 的个人将受到监控并转介至 ICanFeelBetter ARMS 程序。将对所有符合 CAARMS 精神病标准的个体进行 DUP 测量。我们 假设在 CMHC 中筛查精神病症状是可行且可接受的，并且 通过筛查确定的 FEP 个体的平均 DUP 将少于 3 个月，即最长时间 精神病症状发作与世界卫生组织建议的 CSC 参与之间的关系 组织。为了优化筛查和治疗参与策略以减少 DUP，我们将 通过对患者进行深入的定性访谈，确定 FEP 护理的促进因素和障碍 护理人员，并绘制 FEP 护理途径。我们还将对以下人士进行深入的定性访谈 临床医生探索他们在筛查和转诊过程中的经验。该项目的调查结果将 通知一项完全有力的对照研究，以评估这种筛查方法是否与传统的方法相比 转诊，可以在病程早期更及时地识别 FEP 病例。