Reducing the Duration of Untreated Psychosis in the United States
Condition: First Episode Psychosis (FEP); At Risk Mental State (ARMS)
MeSH terms: Psychotic Disorders; Mental Disorders
Study type: Observational

Summary: 
      The goal of this project is to investigate whether a systematic screening approach for
      individuals with first episode psychosis (FEP) can substantially reduce Duration of Untreated
      Psychosis (DUP). The study team will evaluate the feasibility of screening a consecutive
      help-seeking population entering mental health services in order to facilitate early
      identification of FEP cases, rapid referral to specialty care and engagement in treatment.
    

Detailed description: 
      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 Prodromal Questionnaire -
      Brief Version (PQ-B). Those who screen positive will be assessed by the Structured Interview
      for Prodromal Syndromes (SIPS) 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 SIPS psychosis criteria. The study team hypothesizes 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, the clinical team will identify facilitators and barriers to FEP care through in-depth
      qualitative interviews with patients and caregivers, and by mapping pathways to FEP care. The
      study team will also conduct in-depth qualitative interviews with clinicians to explore their
      experience with the screening and referral process.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Individuals ages 12 to 30 entering child/adolescent and adult community mental health
        clinics.
      
Keywords: Screening; Duration of Untreated Psychosis (DUP); Coordinated Specialty Care (CSC); First Episode Psychosis (FEP); At Risk Mental State (ARMS); Clinical High Risk for Psychosis (CHR)