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BMC Psychiatry
Published in: BMC Psychiatry 1/2014

Open Access 01-12-2014 | Study protocol

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

Authors: Vinod H Srihari, Cenk Tek, Jessica Pollard, Suzannah Zimmet, Jane Keat, John D Cahill, Suat Kucukgoncu, Barbara C Walsh, Fangyong Li, Ralitza Gueorguieva, Nina Levine, Raquelle I Mesholam-Gately, Michelle Friedman-Yakoobian, Larry J Seidman, Matcheri S Keshavan, Thomas H McGlashan, Scott W Woods

Published in: BMC Psychiatry | Issue 1/2014

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Abstract

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 (PREPR) 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 PREPR 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. Registered 20 February 2014.
Appendix
Available only for authorised users
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Metadata
Title
Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study
Authors
Vinod H Srihari
Cenk Tek
Jessica Pollard
Suzannah Zimmet
Jane Keat
John D Cahill
Suat Kucukgoncu
Barbara C Walsh
Fangyong Li
Ralitza Gueorguieva
Nina Levine
Raquelle I Mesholam-Gately
Michelle Friedman-Yakoobian
Larry J Seidman
Matcheri S Keshavan
Thomas H McGlashan
Scott W Woods
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-014-0335-3

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