Clinical High Risk for Psychosis, First Episode Psychosis, Psychosis
Conditions
Brief summary
The objective of the proposed study is to determine the feasibility of an Early Detection program that aims to: (i) identify college students at clinical high risk (CHR) of psychosis or with first episode psychosis (FEP), and (ii) efficiently link them to coordinated specialty care (CSC) services for a 2nd stage screen, a clinical assessment, and appropriate treatment. The study will also determine pathways to care and perceived barriers to care among those students enrolled in Coordinated Specialty Care.
Detailed description
Long duration of untreated psychosis (DUP) is associated with poor outcomes, including higher rates of suicide, hospitalization, and overall low functioning. More widespread use of effective strategies to decrease DUP are needed to address the substantial discrepancy between the actual (i.e., on average 2 years) and recommended time (i.e., 3 months) between the appearance of psychotic symptoms and the initiation of treatment. Early detection (ED) programs aim to decrease DUP by increasing case identification and removal of barriers to coordinated specialty care (CSC). The most studied components of ED programs include: (i) educational campaigns; ED response teams designed to optimize the referral processes to CSC; and to a lesser extent, screening among high-risk groups. While results of studies on individual ED components have been inconsistent, combinations of ED components have had more success in reducing DUP. For example, the Treatment and Intervention in Psychosis ED program, which included educational campaigns and ED teams, reported an average decrease in DUP from 1.5 years to 0.5 years pre-post implementation. The evidence on community-based ED programs is large and growing but very little is known about the effectiveness of ED services on college campuses in the United States. This gap in the literature is problematic because, with the first symptoms of psychosis being most likely to surface among college age young adults, college campuses are critical locations to identify and refer individuals to CSC who are at increased risk of first episode psychosis (FEP). The investigators aim to address this gap in the literature. The long-term goal of this program of research is to improve clinical and functional outcomes among college students with early stages of psychosis by reducing DUP. The objective of the proposed study is to determine the feasibility of an ED program that aims to: (i) identify college students at CHR of psychosis or with FEP, and (ii) efficiently link them to CSC services for a 2nd stage screen and a clinical assessment among those determined eligible. Students will be referred to treatment based on the results of the assessment (the University of New Mexico Department of Psychiatry CSC program includes clinical services for both FEP and CHR). The study will also determine pathways to care and perceived barriers to care among those students enrolled in Coordinated Specialty Care.
Interventions
None listed
Sponsors
National Institute of Mental Health (NIMH)
University of New Mexico
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
15 Years to 30 Years
Healthy volunteers
Yes
Inclusion criteria
1. 15-30 year-old college students who present to the University of New Mexico (UNM) Early Program or the UNM CONNECT program for an intake, 2. screen positive for clinical high risk on the Structured Interview for Prodromal Syndromes (SIPS) or first episode psychosis on the Structured Clinical Interview for Diagnostic Statistical Manual IV 3. agree to participate in the study.
Exclusion criteria
1. below the age of 15 years old or above the age of 30, 2. not UNM college students, 3. screen negative for clinical high risk or first episode psychosis, 4. refuse to participate in the study, 5. cognitively unable to provide informed consent as demonstrated by a brief cognitive screen prior to completion of the enrollment interview
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Untreated Psychosis | Measured upon admission (baseline) to coordinated specialty care (CSC) | Duration of Untreated Psychosis determined upon enrollment to coordinated specialty care |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Steps to Coordinated Specialty Care | Measured upon admission (baseline) to coordinated specialty care (CSC) | Measured among those who meet criteria for first episode psychosis or clinical high risk using the Circumstances of Onset and Relapse Schedule, and is operationalized as the number of steps between the onset of symptoms and admission to CSC for first episode psychosis or clinic high risk. The CORS includes the Topography of Psychotic Episode (TOPE), which traces the process of seeking treatment by identifying step-by-step contacts with medical, mental health, and/or community services in the pathway toward enrollment in CSC. Participants were asked if they had ever sought out a particular service or professional for mental health problems, and if so, the approximate date of that encounter. |
| Perceived Barriers to Seeking Psychological Help | Measured upon admission (baseline) to coordinated specialty care (CSC). | Measured among those who meet criteria for first episode psychosis or clinical high risk by the Barriers to Seeking Psychological Help Scale (BSPHS), developed to measure barriers related to psychological help-seeking for college students. The self-report scale includes 17 items rated on a five point scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The scale includes five subscales: (1) fear of being stigmatized by society, (2) trust in the mental health professional, (3) difficulties in self-disclosure, (4) perceived devaluation, and, (5) lack of knowledge. BSPHS total score and scores for all subscales are determined by taking the mean of responses to all items for the entire scale and the mean of responses for each subscale, respectively. Higher scores indicate higher perceived barriers for the entire scale and all subscales. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Students Enrolled in Coordinated Specialty Care Students Enrolled In Coordinated Specialty Care that were originally identified through the PQ-B screen implemented in the college counseling center | 24 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lost to Follow-up | 1 |
Baseline characteristics
| Characteristic | Students Enrolled in Coordinated Specialty Care |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 24 Participants |
| Age, Continuous | 21.4 Years STANDARD_DEVIATION 2.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 13 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Region of Enrollment United States | 24 participants |
| Sex: Female, Male Female | 16 Participants |
| Sex: Female, Male Male | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 25 |
| other Total, other adverse events | 0 / 25 |
| serious Total, serious adverse events | 0 / 25 |
Outcome results
Primary
Duration of Untreated Psychosis
Duration of Untreated Psychosis determined upon enrollment to coordinated specialty care
Time frame: Measured upon admission (baseline) to coordinated specialty care (CSC)
Population: 17 of the participants were determined to be at clinical high risk of psychosis rather than experiencing first episode psychosis. Duration of untreated psychosis can not be determined for participants at clinical high risk of psychosis. The other seven participants were determined to be experiencing their first episode of psychosis however were missing data on duration of psychosis.
Secondary
Number of Steps to Coordinated Specialty Care
Measured among those who meet criteria for first episode psychosis or clinical high risk using the Circumstances of Onset and Relapse Schedule, and is operationalized as the number of steps between the onset of symptoms and admission to CSC for first episode psychosis or clinic high risk. The CORS includes the Topography of Psychotic Episode (TOPE), which traces the process of seeking treatment by identifying step-by-step contacts with medical, mental health, and/or community services in the pathway toward enrollment in CSC. Participants were asked if they had ever sought out a particular service or professional for mental health problems, and if so, the approximate date of that encounter.
Time frame: Measured upon admission (baseline) to coordinated specialty care (CSC)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Students Enrolled in Coordinated Specialty Care | Number of Steps to Coordinated Specialty Care | 5.71 Number of contacts prior to CSC | Standard Deviation 3.7 |
Secondary
Perceived Barriers to Seeking Psychological Help
Measured among those who meet criteria for first episode psychosis or clinical high risk by the Barriers to Seeking Psychological Help Scale (BSPHS), developed to measure barriers related to psychological help-seeking for college students. The self-report scale includes 17 items rated on a five point scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The scale includes five subscales: (1) fear of being stigmatized by society, (2) trust in the mental health professional, (3) difficulties in self-disclosure, (4) perceived devaluation, and, (5) lack of knowledge. BSPHS total score and scores for all subscales are determined by taking the mean of responses to all items for the entire scale and the mean of responses for each subscale, respectively. Higher scores indicate higher perceived barriers for the entire scale and all subscales.
Time frame: Measured upon admission (baseline) to coordinated specialty care (CSC).
Population: Student enrolled in Coordinated Specialty Care that completed the Barriers to Seeking Psychological Help Scale
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Total Perceived Barriers to Care Mean Score | 2.58 score on a scale | Standard Deviation 0.55 |
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Fear of being stigmatized by society subscale mean score | 2.68 score on a scale | Standard Deviation 0.85 |
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Trust in the mental health professional subscale mean score | 2.70 score on a scale | Standard Deviation 0.69 |
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Difficulties in self-disclosure subscale mean score | 2.57 score on a scale | Standard Deviation 0.91 |
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Perceived devaluation subscale mean score | 2.39 score on a scale | Standard Deviation 0.94 |
| Students Enrolled in Coordinated Specialty Care | Perceived Barriers to Seeking Psychological Help | Lack of knowledge subscale mean score | 2.51 score on a scale | Standard Deviation 0.83 |