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

早期识别和参与以减少未经治疗的精神病的持续时间 (EaSIE)

• 批准号: 9457105
• 负责人: Yulia Landa
• 金额: $ 28.34万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-19 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9457105
• 关键词: Adolescence; Adolescent; Adolescent and Young Adult; Adult; Age; Attenuated; Caregivers; Caring; Child; Clinic; Cognitive Therapy; Communication; Communities; Community Health Systems; Community Mental Health Services; Consent; Controlled Study; Detection; Deterioration; Early Diagnosis; Early Intervention; Early identification; Economics; Enrollment; Equipment and supply inventories; Evaluation; Family; Feedback; Goals; Health system; Healthcare; Impairment; Individual; Interview; Knowledge; Maps; Measures; Mental Health; Mental Health Services; Methods; Monitor; Netherlands; Outpatients; Pathway interactions; Patients; Phase; Population; Prevention education; Procedures; Process; Psychotic Disorders; Questionnaires; Recommendation; Recovery; Rehabilitation therapy; Risk; Route; Schizophrenia; Services; Social Development; Societies; Symptoms; Time; TimeLine; Treatment Cost; Treatment outcome; Visual; World Health Organization; Youth; base; cognitive development; cognitive function; disability; education evaluation; emerging adult; experience; first episode psychosis; functional decline; functional restoration; help-seeking behavior; improved; improved outcome; intervention program; medical specialties; mental health center; mental state; prevent; productivity loss; programs; psychiatric disability; psychosocial; psychotic symptoms; public health relevance; reduce symptoms; screening; symptom treatment

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.

项目摘要/摘要 精神病通常在青少年后期或成年初出现，在社会和认知的重要阶段 发展，这可能会对个人的长期运作产生深远的不利影响。很多的 研究发现，精神病的发作与专业治疗的倡议首次延迟 情节精神病（FEP），未经治疗的精神病（DUP）的持续时间通常在美国一年 需要更好的检测策略来改善对FEP的个体的识别并迅速参与 他们在协调的专业护理（CSC）中，旨在恢复功能。精神病的发作先于 以前期阶段为特征，其特征是衰减的精神病症状和功能下降。这个阶段 （处于危险的精神状态：武器）是旨在通过减少DUP改善结果的策略的潜在目标 通过常规症状监测。这项研究将调查美国成功改编 荷兰的检测方法可以减少美国环境中的DUP。荷兰研究发现 筛选连续的寻求帮助的人群进入心理健康服务的捕获更多 FEP和武器病例比精神卫生中心的临床转诊。因此，筛选可能是 在患病过程中早期识别患有精神病症状的人的有效策略。 这项研究将实施并评估社区心理中精神病症状的系统筛查 卫生诊所为了促进快速识别和参与FEP患者的治疗。 12至30岁的个人进入儿童/青少年和成人社区心理健康诊所（CMHC） Sinai Mount Health System将通过16个项目版本的Promomal问卷（PQ-16）进行筛选。 那些筛选阳性的人将通过对处于危险的精神状态进行全面评估来评估 （CAARMS），并参考了特定阶段的专业护理。 FEP的个人将转介给CSC 程序：Ontrackny和Peer。武器的个人将受到监视并转介给icanfeelbetter 武器计划。 DUP将针对所有符合CAARMS精神病标准的人进行衡量。我们 假设筛查CMHC中的精神病症状将是可行和可接受的，并且 通过筛查确定的FEP个体的平均DUP将少于3个月，最长时间 在精神病症状的发作和世界健康推荐的CSC参与之间 组织。为了优化减少DUP的筛查和治疗参与策略，我们将 通过与患者进行深入的定性访谈，确定促进者和FEP护理的障碍 护理人员，并通过绘制FEP护理途径。我们还将与 临床医生探索他们在筛查和推荐过程中的经验。这个项目的发现将 告知一项完全有动力的对照研究，以评估这种筛选方法是否与传统相比 推荐，导致更早地鉴定出疾病的早期FEP病例。