Improving Clinician Recognition of Early Psychosis with an Interactive Online Cou

描述（由申请人提供）：由于多种原因，治疗延迟是精神分裂症和相关精神障碍临床管理中最严重的缺陷之一。未经治疗的精神病是令人痛苦的，破坏正常的发展，并与行为障碍，可能是尴尬的，侵略性的或有法律的后果。此外，未经治疗的精神病（DUP）的持续时间已成为一个独立的预测的可能性和程度的恢复从最初的第一次发作，因此可能是一个潜在的可修改的预后因素。2005年，我们建立了北卡罗来纳州大学外展和支持干预服务（OASIS），这是美国首批专门治疗首次精神病发作的临床项目之一。我们在首次发作患者中进行的当地护理途径研究的结果与文献一致，从精神病发作到开始抗精神病药物治疗的平均延迟时间为18个月。研究参与者的治疗延迟主要是由于患者、患者身边的人、社区临床医生和法律的系统缺乏意识，即主观和行为困难是由于新出现的精神病造成的。虽然DUP问题的需求方和供应方都需要解决，但我们建议提高社区临床医生对首次精神病发作评估的意识和技能是关键一步。我们 建议设计良好的在线继续教育课程有可能有效解决供应方的不足，并有可能广泛传播。我们将基准DUP和途径，以照顾病人转介到OASIS计划，以告知在线课程开发，特别是澄清目标受众，并评估课程参与对DUP的影响，为新的OASIS转介。我们将发展和确定“早期识别精神病：机会之窗”课程的有效性，以发展临床医生对早期识别精神病的重要性的认识，识别精神病“警告信号”的能力以及在临床实践中早期识别策略的表现。最后，我们将确定课程推广工作是否会影响参加在线课程的当地社区临床医生的数量。

DESCRIPTION (provided by applicant): For a number of reasons treatment delay is one of the most serious deficiencies in the clinical management of schizophrenia and related psychotic disorders. Untreated psychosis is distressing, derails normal development and is associated with behavioral disturbances that may be embarrassing, aggressive or have legal consequences. In addition, duration of untreated psychosis (DUP) has emerged as an independent predictor of likelihood and extent of recovery from an initial first episode and thus may be a potentially modifiable prognostic factor. In 2005, we established the University of North Carolina Outreach and Support Intervention Services (OASIS), one of the first US clinical programs specializing in treatment of a first episode of psychosis. Findings from our local pathways to care study in first episode patients are consistent with the literature, with average delays of 18 months from onset of psychosis to initiation of antipsychotic treatment. Treatment delays in study participants mainly stemmed from a lack of awareness by the patient, persons close to the patient, community clinicians and the legal system that the subjective and behavioral difficulties were due to emerging psychosis. While both the demand- and the supply-sides of the DUP problem need to be addressed, we propose that enhancing community clinicians' awareness and skills in the evaluation of the first psychotic episode is a key step. We propose that a well-designed online continuing education course has the potential to address supply-side deficiencies effectively, with a potential for broad dissemination. We will benchmark DUP and pathways to care in patients referred to the OASIS program to inform online course development, especially to clarify the target audience, and to assess the impact of course participation on DUP for new OASIS referrals. We will develop and determine the effectiveness of the course, "Recognizing Psychosis in the Early Stages: A Window of Opportunity", to the development of clinicians' knowledge of the importance of early recognition of psychosis, competence in recognizing "warning signs" for psychosis and performance of early recognition strategies in clinical practice. Finally, we will determine if course promotion efforts impact the numbers of local community clinicians who take the online course.