Early Stage Identification and Engagement to Reduce the Duration of Untreated Psychosis: Evaluating the Impact of Screening and Systematic Communication

早期识别和参与以缩短未经治疗的精神病的持续时间：评估筛查和系统沟通的影响

• 批准号: 10676948
• 负责人: Yulia Landa
• 金额: $ 81.28万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676948
• 关键词: Administrator; Age; Attitude; Caring; Client satisfaction; Clinic; Communication; Communication Methods; Communities; Consolidated Framework for Implementation Research; Consultations; Coordinated Specialty Care; Data; Detection; Early Diagnosis; Early Intervention; Early identification; Economics; Equipment and supply inventories; Family; Future; Health system; Hybrids; Impairment; Individual; Intervention; Interview; Knowledge; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; National Institute of Mental Health; Netherlands; New York; Outcome; Patients; Population; Procedures; Psychoses; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Recovery of Function; Research; Schizophrenia; Services; Societies; Structure; Symptoms; Taxonomy; Time; Training; Treatment Cost; Treatment outcome; Youth; aged; attenuated psychosis syndrome; clinical high risk for psychosis; community clinic; design; disability; duration of untreated psychosis; effectiveness testing; first episode psychosis; functional restoration; help-seeking behavior; implementation barriers; implementation determinants; implementation facilitators; implementation strategy; implementation study; improved; innovation; medical specialties; practice setting; productivity loss; programs; psychiatric disability; psychosis risk; psychosocial; psychotic symptoms; public health relevance; recruit; reduce symptoms; routine practice; routine screening; screening; service engagement; social stigma; trial design

PROJECT SUMMARY/ABSTRACT 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 strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands enhanced by an innovative model of communicating information about psychosis and treatment options to patients and families (ComPsych), can reduce DUP. Our collaborators in the Netherlands compared screening of a consecutive help-seeking population entering mental health services to clinician referral from mental health clinics and found that screening captured significantly more individuals at clinical high risk for psychosis (CHR) and with FEP. Based on the Dutch model, within the Mount Sinai Health System in New York, we have piloted and established the feasibility of screening help-seeking youth entering mental health services with the aim of improving early identification of FEP cases and rapid referral to specialty care (Early Stage Identification and Engagement to Reduce DUP study (EaSIE), supported by NIMH R34). Individuals entering services are screened with the Prodromal Questionnaire-Brief Version (PQ-B). Those who screen positive are assessed by Structured Interview for Psychosis Risk Syndromes (SIPS) and referred to stage-specific specialty care (FEP or CHR services). To facilitate service engagement we developed, piloted, and established feasibility of the ComPsych model. While our data showed that compared to clinician referral, systematic screening method (SM) can substantially reduce DUP by identifying a greater number of patients earlier in the course of illness, more research is needed to evaluate the impact of ComPsych on FEP treatment initiation and engagement in order to further reduce DUP. We will use a stepped-wedge cluster randomized controlled trial design to compare a systematic screening and communication method (SCM) to SM. Following a 6-month baseline period of SM, 12 mental health clinics will be randomized (2 clinics at a time) to transition from SM to SCM at 6-month intervals. In both conditions, individuals aged 12-30 who screen positive on PQ-B will be assessed with SIPS by trained clinicians in each clinic and referred to FEP and CHR services as appropriate. In SCM condition the ComPsych model will be used to facilitate initiation of CHR and FEP services. We will measure DUP for patients who meet psychosis criteria. We hypothesize that: (1) SCM will result in a higher number of individuals initiating CHR and FEP services compared to SM; (2) The mean DUP of FEP individuals in SCM condition will be lower than the mean DUP of FEP individuals in SM condition, due to the reduced time to initiate FEP services. We will also examine multi-level implementation factors that can inform the identification of implementation strategies for future deployment of SCM in routine practice.

项目概要/摘要 研究发现，精神病的发作和首次专业治疗的开始之间有相当大的延迟。 在美国，发作性精神病 (FEP) 未经治疗的精神病 (DUP) 持续时间通常超过一年 需要更好的策略来提高对 FEP 患者的识别并让他们快速参与 旨在恢复功能的协调专业护理 (CSC)。这项研究将调查美国是否 采用荷兰成功的检测方法，并通过创新模型加强 向患者和家属传达有关精神病和治疗方案的信息 (ComPsych)，可以 减少DUP。我们在荷兰的合作者比较了连续寻求帮助的筛选 接受心理健康服务的人群向心理健康诊所转诊的临床医生发现 筛查捕获了更多临床精神病 (CHR) 高风险人群和 FEP 患者。基于 根据荷兰模式，我们在纽约西奈山卫生系统内试点并建立了 对寻求帮助的青少年进行心理健康服务筛查以早期改善的可行性 识别 FEP 病例并快速转诊至专业护理（早期识别和参与 减少 DUP 研究（EaSIE），由 NIMH R34 支持）。进入服务的个人都经过筛选 前驱问卷-简短版（PQ-B）。那些筛查呈阳性的人将接受结构化评估 精神病风险综合症 (SIPS) 访谈并转介至特定阶段的专业护理（FEP 或 CHR 服务）。为了促进服务参与，我们开发、试点了 ComPsych 并建立了可行性 模型。虽然我们的数据表明，与临床医生转诊相比，系统筛查方法（SM）可以 通过在病程早期识别更多患者，显着减少 DUP 需要进行研究来评估 ComPsych 对 FEP 治疗开始和参与的影响，以便 进一步减少DUP。我们将使用阶梯楔形聚类随机对照试验设计来比较 对 SM 的系统筛选和沟通方法 (SCM)。经过 6 个月的 SM 基线期后， 12 个心理健康诊所将被随机（每次 2 个诊所）在 6 个月内从 SM 过渡到 SCM 间隔。在这两种情况下，PQ-B 筛查呈阳性的 12-30 岁个人将接受 SIPS 评估 由每个诊所经过培训的临床医生进行，并酌情转介至 FEP 和 CHR 服务。在单片机条件下 ComPsych 模型将用于促进 CHR 和 FEP 服务的启动。我们将测量 DUP 符合精神病标准的患者。我们假设：（1）SCM 将导致更多的个体 与SM相比，启动CHR和FEP服务； (2) SCM条件下FEP个体的平均DUP为 由于启动 FEP 的时间减少，低于 SM 条件下 FEP 个体的平均 DUP 服务。我们还将研究多层次的实施因素，这些因素可以帮助识别 未来在日常实践中部署 SCM 的实施策略。