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This cluster randomized clinical trial assesses whether the use of population-based electronic screening in addition to standard targeted clinician education increases the early detection of psychosis and decreases the duration of untreated psychosis, compared with clinician education alone. Key Points: Question: Does population-based electronic screening for first-episode psychosis (FEP) or psychosis spectrum disorder in community settings increase early detection and reduce the duration of untreated psychosis? Findings: In this cluster randomized clinical trial, a population-based technology-enhanced screening plus clinician education identified more individuals with psychosis spectrum disorder than clinician education alone. No significant difference in duration of untreated psychosis for FEP across groups was detected. Meaning: Population-based screening for FEP in community mental health settings substantially increases identification of individuals with psychosis spectrum disorders but does not reduce the overall duration of untreated psychosis, so reduction efforts must also specifically target delays between symptom onset and first contact with mental health services. Importance: Reducing the duration of untreated psychosis (DUP) is essential to improving outcomes for people with first-episode psychosis (FEP). Current US approaches are insufficient to reduce DUP to international standards of less than 90 days. Objective: To determine whether population-based electronic screening in addition to standard targeted clinician education increases early detection of psychosis and decreases DUP, compared with clinician education alone. Design, Setting, and Participants: This cluster randomized clinical trial included individuals aged 12 to 30 years presenting for services between March 2015 and September 2017 at participating sites that included community mental health clinics and school support and special education services. Eligible participants were referred to the Early Diagnosis and Preventative Treatment (EDAPT) Clinic. Data analyses were performed in September and October 2019 for the primary and secondary analyses, with the exploratory subgroup analyses completed in May 2021. Interventions: All sites in both groups received targeted education about early psychosis for health care professionals. In the active screening group, clients also completed the Prodromal Questionnaire–Brief using tablets at intake; referrals were based on those scores and clinical judgment. In the group receiving treatment as usual (TAU), referrals were based on clinical judgment alone. Main Outcomes and Measures: Primary outcomes included DUP, defined as the period from full psychosis onset to the date of the EDAPT diagnostic telephone interview, and the number of individuals identified with FEP or a psychosis spectrum disorder. Exploratory analyses examined differences by site type, completion rates between conditions, and days from service entry to telephone interview. Results: Twenty-four sites agreed to participate, and 12 sites were randomized to either the active screening or TAU group. However, only 10 community clinics and 4 school sites were able to fully implement population screening and were included in the final analysis. The total potentially eligible population size within each study group was similar, with 2432 individuals entering at active screening group sites and 2455 at TAU group sites. A total of 303 diagnostic telephone interviews were completed (178 [58.7%] female individuals; mean [SD] age, 17.09 years [4.57]). Active screening sites reported a significantly higher detection rate of psychosis spectrum disorders (136 cases [5.6%], relative to 65 [2.6%]; P <.001) and referred a higher proportion of individuals with FEP and DUP less than 90 days (13 cases, relative to 4; odds ratio, 0.30; 95% CI, 0.10-0.93; P =.03). There was no difference in mean (SD) DUP between groups (active screening group, 239.0 days [207.4]; TAU group 262.3 days [170.2]). Conclusions and Relevance: In this cluster trial, population-based technology-enhanced screening across community settings detected more than twice as many individuals with psychosis spectrum disorders compared with clinical judgment alone but did not reduce DUP. Screening could identify people undetected in US mental health services. Significant DUP reduction may require interventions to reduce time to the first mental health contact. Trial Registration: ClinicalTrials.gov Identifier: NCT02841956 [ABSTRACT FROM AUTHOR]

Opioid detoxification over a six-month period does not appear to be more effective than methadone maintenance treatment (MMT). MMT is effective for treating opioid addiction, but methadone is also addictive. Researchers randomly assigned 154 drug addicts to receive MMT or a six-month detoxification program that included psychosocial therapy, education and group therapy. Drug users in the MMT group were more likely to comply with treatment and less likely to use heroin than those in the detoxification group.