Reducing the Duration of Untreated Psychosis in the United States

Psychosis typically emerges in late adolescence or early adulthood, during a vital stage in
social and cognitive development, which can have a profoundly adverse impact on an
individual's long-term functioning. Numerous studies find a substantial delay between the
onset of psychosis and the initiation of specialty treatment for first episode psychosis
(FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S.
Better detection strategies are needed to improve identification of individuals with FEP and
to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning.
The onset of psychosis is preceded by a prodromal phase characterized by attenuated psychotic
symptoms and decline in functioning. This phase (at-risk mental state: ARMS) is a potential
target for strategies aimed at improving outcome by reducing DUP through regular symptom
monitoring. This study will investigate whether a U.S. adaptation of a successful detection
approach from the Netherlands can reduce DUP in the U.S. setting. The Dutch study found that
screening of a consecutive help-seeking population entering mental health services captures
significantly more FEP and ARMS cases than clinician referrals from mental health centers.
Therefore screening may be an effective strategy for identifying individuals with psychotic
symptoms earlier on in the course of their illness. This study will implement and evaluate a
systematic screening for psychotic symptoms in community mental health clinics in order to
facilitate rapid identification and engagement in treatment of individuals with FEP.
Individuals ages 12 to 30 entering child/adolescent and adult community mental health clinics
(CMHCs) within Mount Sinai Health System will be screened with the Prodromal Questionnaire -
Brief Version (PQ-B). Those who screen positive will be assessed by the Structured Interview
for Prodromal Syndromes (SIPS) and referred to stage-specific specialty care. Individuals
with FEP will be referred to CSC programs: OnTrackNY and PEER. Individuals with ARMS will be
monitored and referred to ICanFeelBetter program for ARMS. DUP will be measured for all
individuals who meet SIPS psychosis criteria. The study team hypothesizes that screening for
psychotic symptoms in CMHCs will be feasible and acceptable, and that the average DUP of FEP
individuals identified with screening will be less than 3 months, the maximum time between
onset of psychotic symptoms and engagement in CSC recommended by the World Health
Organization. In order to optimize screening and treatment engagement strategies for reducing
DUP, the clinical team will identify facilitators and barriers to FEP care through in-depth
qualitative interviews with patients and caregivers, and by mapping pathways to FEP care. The
study team will also conduct in-depth qualitative interviews with clinicians to explore their
experience with the screening and referral process.

Inclusion Criteria:

- age 12- 30

- ability to participate in assessments in English

- ability to provide informed consent (assent for those under age 18)

- meet criteria for psychosis or psychosis risk on SIPS

Exclusion Criteria:

- previous diagnosis of schizophrenia or schizoaffective disorder.