Clinical trial NCT02841956: Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement
Official title: Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Psychotic Disorders
Lead sponsor: University of California, Davis
Sponsor class: OTHER
Collaborators: name: National Institute of Mental Health (NIMH)
First posted: 2016-07-22
Enrollment: 427
Sex: ALL
Minimum age (years): 12
Maximum age (years): 30
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SCREENING

Brief summary: Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term outcomes in young people with a first episode of psychosis (FEP). The "standard of FEP care" within the US focuses on targeted provider education regarding signs and symptoms of early psychosis to motivate patient referrals to FEP services, followed by initiation of services within largely clinic-based settings Experience at the Early Diagnosis and Preventive Treatment (EDAPT) FEP specialty program at U.C. Davis in Sacramento has identified two important bottlenecks to reducing DUP, consistent with reports in the literature from other FEP clinics. These are 1) delays in the identification of psychotic symptoms by referral sources, and 2) delays or disruptions of patient engagement in specialty FEP care. Building upon a comprehensive and established referral network of 20 sites across the Sacramento area (schools/universities, ER/inpatient hospitals, outpatient mental health, primary care), the investigators will address delays in patient identification and engagement using a two-phase, cluster randomized design. The investigators will consecutively test the impact of two interventions to reduce DUP, defined in this RFA as time from first onset of psychotic symptoms to engagement in FEP specialty care. To address identification delays, the investigators will examine the use of standard targeted provider education plus novel technology-enhanced screening compared to standard targeted provider education alone, testing the hypothesis that the education plus technology-enhanced screening will identify more patients, earlier in their illness. To address engagement delays, the investigators will compare the use of a mobile community-based, telepsychiatry-enhanced engagement team to standard clinic-based procedures for intake, engagement and initiation of treatment, to test the hypothesis that the mobile approach facilitates earlier and more stable engagement, thereby reducing DUP. The proposed work will provide new specific evidence-based practices for reducing DUP and improving outcomes through specialty care of individuals with a first episode of psychosis.


Eligibility criteria: Inclusion criteria:

Meet DSM-IV criteria for a diagnosis of affective or nonaffective psychosis.

Exclusion criteria:

1. Duration of psychosis \> 2 years
2. Current substance dependence
3. Neurological illness or injury leading to psychotic symptoms
4. Only substance induced psychotic symptoms
5. Documented IQ \< 70
6. Lack of English fluency

Primary outcomes:
measure: Days of active psychosis between onset of illness and identification for care (Duration of untreated psychosis)
timeFrame: Day 1
Secondary outcomes:
measure: Rates of patient enrollment in first episode psychosis care
timeFrame: Baseline
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: University of California Davis Early Diagnosis and Preventative Treatment (EDAPT) Clinic
state: California
Study officials:
References: