Improving Clinician Recognition of Early Psychosis with an Interactive Online Cou

描述（由申请人提供）：由于许多原因，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，破坏了正常的发育，并与可能令人尴尬、具有攻击性或有法律后果的行为障碍有关。此外，未治疗精神病的持续时间（DUP）已成为一个独立的预测因素，从最初的首次发作恢复的可能性和程度，因此可能是一个潜在的可改变的预后因素。2005年，我们建立了北卡罗来纳大学外展和支持干预服务（OASIS），这是美国第一个专门治疗首发精神病的临床项目之一。我们对首发患者的局部护理途径研究结果与文献一致，从精神病发作到开始抗精神病药物治疗平均延迟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系统缺乏对主观和行为困难是由新发精神病引起的认识。虽然DUP问题的供需双方都需要解决，但我们建议提高社区临床医生在首次精神病发作评估中的意识和技能是关键的一步。我们

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.