Psychosis: Early Detection, Intervention and Prevention
Condition: Prodromal Schizophrenia; Psychotic Disorders; Severe Bipolar Disorder With Psychotic Features; Severe Major Depression With Psychotic Features
MeSH terms: Schizophrenia; Bipolar Disorder; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The primary aim of this application is to conduct a randomized, controlled clinical trial of
      a specialized mental health service delivery system specifically developed for prodromal
      psychotic disorders. The intervention is Family-aided Assertive Community Treatment (FACT).
      The goal of the treatment is prevention of psychosis and disability. This study will assess
      experimentally the clinical effectiveness of this new type of mental health service. Other
      domains of outcome include cognitive dysfunction and functional disability.
    

Detailed description: 
      The proposed study will be part of a larger program, Portland Identification and Early
      Referral (PIER), under foundation, NIH and Center for Mental Health Services sponsorship,
      that has established a population-based system of early detection for Greater Portland,
      Maine. Previous and present effort has educated and trained the community-at-large and all
      health, education and other professionals, with the result that referrals are occurring at
      the expected frequency. The principal strategy is to intervene early, prior to onset, in the
      course of the onset of psychotic disorders to arrest the development of psychotic symptoms
      and functional disability. The test treatment is a specialized combination of
      psychoeducational multifamily group and assertive community treatment.

      The project will support a team of clinical staff with the ability to: a. foster detection of
      prodromal disorders in the Greater Portland community by general practitioners, guidance
      counselors, mental health professionals and the general public; b. accurately assess
      individuals at high risk for psychosis; c. reliably deliver an evidence-based psychosocial
      and, if indicated, pharmacological treatment package using standardized methodology. The
      research study will test, in a randomized controlled trial, the symptomatic and functional
      outcome of treatment in 100 subjects ages 12 to 35 identified by that system. It will allow
      the analysis of key social factors contributing to psychosis and their interaction with the
      treatment conditions and each other.
    

Intervention name(s): Family-aided Assertive Community Treatment; Enhanced standard treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The experimental treatment is a combination of family psychoeducation, assertive community treatment, supported education/employment and psychotropic medication.; In this arm, the subjects will receive the same psychotropic drugs, but will receive individual case management, family education and crisis intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Prodromal; Schizophrenia; Psychosis; Family psychoeducation; Assertive community treatment; Supported employment; Supported education