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

描述（由申请人提供）：近年来的一个关键发展是互联网和社交媒体的使用量大幅增长，特别是在年轻人中。我们建议利用互联网和社交媒体开展三个综合性、探索性/发展性项目，旨在减少未经治疗的精神病（DUP）的持续时间。在美国，每年大约有10万青少年和年轻人经历精神病（FEP）的首次发作。尽管症状严重且功能下降，但在美国，症状发作和接受适当护理之间的时间平均为2年。来自我们正在进行的NIMH资助的初始精神分裂症发作后恢复（RAISE）项目的数据，在美国34家诊所进行，涉及404名FEP患者，表明未经治疗的精神病（DUP）的中位持续时间为74周。北美前驱症状纵向研究（NAPLS）显示了类似的时期（即，2年），在此期间，出现的减弱症状发展为全面的精神病（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，在开始治疗之前的活动（减弱加全面）症状的总时间平均可能为4年;此外，他们的“护理途径”往往不太理想。DUP时间越长，独立预测更多的再入院，症状严重程度越高，生活质量越差。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诊具有FEP前驱（减弱阳性）症状或体征和症状的患者，以便及时进行专业治疗。这些项目将建立具体方法的可接受性和可行性：（1）我们将完善一个访谈，这是第一个记录互联网和社交媒体在每个年轻人的精神病或减弱的精神病症状的演变过程中被利用的情况。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/社交梅达，以改善护理途径，并帮助引导患者更及时地接受治疗。(2)我们将测试使用电子调查工具的可行性与大学生，它可以提供匿名的自我评估精神病的早期迹象，链接到教育网站和转诊到既定的第一集节目为那些谁得分高于指定的阈值。(3)我们还将与纽约市两所顶级公立和私立高中的学生团队合作，让他们参与竞争奖项，以开发有前途的互联网和社交媒体策略，以识别精神病高危青年或FEP，并将他们与治疗联系起来。学生们还将就项目的其他方面向我们提出建议。所有这些工作的目的是开发和完善策略，用于后续的大规模研究，旨在证明我们通过互联网和社交媒体策略显着减少美国DUP的能力。

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.