1. Effect of Technology-Enhanced Screening in Addition to Standard Targeted Clinician Education on the Duration of Untreated Psychosis
- Author
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Niendam, Tara A, Loewy, Rachel, Savill, Mark, Delucchi, Kevin L, Lesh, Tyler A, Ragland, J Daniel, Bolden, Khalima, Skymba, Haley V, Gobrial, Sarah, Meyer, Monet S, Pierce, Katherine M, Rosenthal, Adi, Fedechko, Taylor L, Tully, Laura M, Tryon, Valerie L, Goldman, Howard, Cress, Rosemary D, Kravitz, Richard L, and Carter, Cameron S
- Subjects
Health Services and Systems ,Health Sciences ,Serious Mental Illness ,Mental Health ,Brain Disorders ,Prevention ,Clinical Trials and Supportive Activities ,Clinical Research ,Health Services ,Mental health ,Good Health and Well Being ,Humans ,Female ,Adolescent ,Male ,Psychotic Disorders ,Mental Health Services ,Educational Status ,Schools ,Other Medical and Health Sciences ,Psychology ,Cognitive Sciences ,Clinical sciences ,Clinical and health psychology - Abstract
ImportanceReducing 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.ObjectiveTo 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 participantsThis 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.InterventionsAll 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 measuresPrimary 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.ResultsTwenty-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
- Published
- 2023