Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study

BMC Psychiatry

Scott W Woods⁴  Thomas H McGlashan⁴  Matcheri S Keshavan²  Larry J Seidman²  Michelle Friedman-Yakoobian²  Raquelle I Mesholam-Gately²  Nina Levine³  Ralitza Gueorguieva¹  Fangyong Li¹  Barbara C Walsh³  Suat Kucukgoncu³  John D Cahill⁴  Jane Keat³  Suzannah Zimmet²  Jessica Pollard⁴  Cenk Tek⁴  Vinod H Srihari⁴ 

[1]Yale Center for Analytical Sciences (YCAS), 300 George Street, New Haven 06511, CT, USA

[2]Commonwealth Research Center, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, 75 Fenwood Road, 5th Floor, Boston 02115, MA, USA

[3]Department of Psychiatry, Yale University, 34 Park Street, New Haven 06519, CT, USA

[4]Connecticut Mental Health Center, 34 Park Street, New Haven 06519, CT, USA

关键词: Health communication campaigns;    Public health campaigns;    First-episode psychosis;    Schizophrenia;    Duration of untreated psychosis;    First-episode services;    Early intervention;   

Others  :  1091592
DOI  :  10.1186/s12888-014-0335-3

 received in 2014-10-21, accepted in 2014-11-13,  发布年份 2014

【 摘 要 】

Background

Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams (‘First-episode Services’ or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES?

Methods/Design

The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREP^R) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREP^R over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral.

Discussion

STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes.

Trial registration

ClinicalTrials.gov: NCT02069925 webcite. Registered 20 February 2014.

【 授权许可】

   
2014 Srihari et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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