Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagement (DUP)

University of California (UC) Davis

Status: Terminated

Conditions: Psychotic Disorders

Treatments: Other: Community Mobile Engagement (Phase 2); Other: Electronic Screen + Education (Phase 1); Other: Clinic based Engagement (Phase 2); Other: Targeted Provider Education (Phase 1)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02841956

R01MH104235 (U.S. NIH Grant/Contract)

608950

Details and patient eligibility

About

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.

Enrollment: 427 patients

Sex: All

Ages: 12 to 30 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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427 participants in 4 patient groups

Electronic Screen + Education (Phase 1)

Experimental group

Description:

Electronic screening of participants and targeted education of providers according to standard EDAPT model.

Treatment:

Other: Electronic Screen + Education (Phase 1)

Targeted Provider Education (Phase 1)

Active Comparator group

Description:

Targeted education of providers according to standard EDAPT model.

Treatment:

Other: Targeted Provider Education (Phase 1)

Community Mobile Engagement (Phase 2)

Experimental group

Description:

Clinical intake interviews take place via videoconference at a location in the community convenient for the participant.

Treatment:

Other: Community Mobile Engagement (Phase 2)

Clinic based Engagement (Phase 2)

Active Comparator group

Description:

Clinical intake interviews take place at the EDAPT clinic.

Treatment:

Other: Clinic based Engagement (Phase 2)