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

项目总结/摘要 精神病通常出现在青春期后期或成年早期，在社会和认知的重要阶段， 这可能对个人的长期功能产生深刻的不利影响。许多 研究发现，精神病发作和开始专科治疗之间有很大的延迟， 精神病发作（FEP），在美国，未经治疗的精神病（DUP）的持续时间通常超过一年。 需要更好的检测策略来提高FEP患者的识别率， 他们在协调专业护理（CSC）旨在恢复功能。精神病的发作是在 以精神病症状减弱和功能下降为特征的前驱期。这个阶段 （处于危险的精神状态：ARMS）是旨在通过减少DUP来改善结局的策略的潜在目标 定期监测症状。这项研究将调查美国是否适应一个成功的 荷兰的检测方法可以减少美国环境中的DUP。荷兰的研究发现， 对进入精神卫生服务的连续求助人群进行筛查， FEP和ARMS病例比精神卫生中心的临床医生转诊病例多。因此，筛查可能是一种 有效的策略，以确定个人与精神病症状的早期在他们的疾病过程中。 本研究将在社区精神科实施一项系统的精神病性症状筛查， 卫生诊所，以促进快速识别和参与治疗患有FEP的个人。 12至30岁的人进入儿童/青少年和成人社区精神卫生诊所（CMHC）， 西奈山卫生系统将使用16项前驱期问卷（PQ-16）进行筛查。 筛查呈阳性的患者将接受风险精神状态综合评估 （CAARMS），并提到特定阶段的专业护理。患有FEP的个人将被转介到CSC 项目：OnTrackNY和PEER。将对ARMS患者进行监测，并将其转介给ICanFeelBetter 武器计划。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中筛查精神病性症状是可行和可接受的， 通过筛选确定的FEP个体的平均DUP将少于3个月， 精神病症状发作与参与世界卫生组织推荐的CSC之间的关系 Organization.为了优化减少DUP的筛查和治疗参与策略，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， 照顾者，并通过映射路径到FEP护理。我们还将进行深入的定性访谈， 临床医生探讨他们的经验与筛选和转诊过程。该项目的结果将 告知一项充分把握度的对照研究，以评估与传统的筛查方法相比， 转介，导致更及时地识别FEP病例在病程的早期。

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.