Psychosis: Early Detection, Intervention and Prevention

描述(申请人提供)：本申请的主要目的是对一种专门为前驱精神障碍开发的专门的精神卫生服务提供系统进行随机对照临床试验。这种干预是家庭辅助的积极社区治疗(FACT)。这项拟议的研究将是一个更大的项目的一部分，波特兰识别和早期转介(PIER)，由基金会和精神健康中心赞助，该项目已经在缅因州的大波特兰建立了一个基于人群的早期检测系统。以往和目前的努力对广大社区和所有卫生、教育和其他专业人员进行了教育和培训，结果是转诊达到了预期的频率。主要战略是在精神病发作过程中，在发病前及早干预，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组合。在试点研究中，这一事实导致了非常低的精神病转化率和非常高的参与率和治疗率，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。 这项研究将从实验上评估这种新型精神卫生服务的临床效果。结果的其他领域包括认知功能障碍和功能残疾。该项目将支持EDIPFACT临床工作人员团队，他们有能力：a.促进全科医生、指导顾问、心理健康专业人员和普通公众对大波特兰社区前驱疾病的检测；b.准确地评估精神病的高风险个人；c.使用标准化方法可靠地提供基于证据的心理社会和药物治疗方案。这项研究将在随机对照试验中测试该系统确定的96名年龄在12岁至35岁之间的受试者的症状和功能结果。它将允许分析导致精神病的关键社会因素，以及它们与治疗条件和彼此之间的相互作用。

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.