STEP-ED: Reducing Duration of Untreated Psychosis and Its Impact in the U.S.

NCT02069925 | Completed DMC

• 2 other identifiers: 13100128461R01MH103831-01
• Study Type: interventional
• Target: 285
• Locations: 1 country
• Sites: 2

Brief Summary

The guiding questions for this study are: can a U.S. adaptation of a successful Scandinavian approach (TIPS) to early detection substantially reduce the duration of untreated psychosis (DUP) and improve outcomes beyond an established first-episode service (FES)? The primary aim of this study is:

1. 1.To determine whether an early detection intervention can reduce DUP in the US, as compared to usual detection. Early detection (ED) will be implemented in one US community (New Haven, CT), and usual detection efforts will continue in another (Boston, MA). DUP will be measured at admission to the corresponding first-episode services (STEP \& PREP) in each community, over one year before and throughout ED implementation. The investigators hypothesize that DUP will be reduced significantly in the early detection site compared to the usual detection site;
2. 2.A secondary aim is to determine whether DUP reduction can augment the outcomes of established FES on outcomes in the U.S. The investigators will measure symptoms, functioning and engagement with treatment at entry and over 1 year at each site. The investigators hypothesize that shorter DUP at one FES (STEP) will predict reduced distress and illness severity at entry and better early outcomes at STEP compared to PREP.

Conditions

Psychosis; Schizophrenia

Outcome Measures

Primary Outcomes (1)

• Duration of Untreated Psychosis (DUP)

  Time from onset of psychosis to first antipsychotic (DUP-Demand); Time from first antipsychotic to enrollment in STEP/PREP (DUP-Supply); Time from onset of psychosis to enrollment in STEP/PREP (DUP-Total)

  One year before, during campaign and one year after end of campaign

Secondary Outcomes (3)

• Levels of social and occupational functioning

  1 year after enrollment in STEP/PREP

• Change in levels of social and occupational functioning- social

  6 months and 12 months

• Change in levels of social and occupational functioning- roles

  6 months and 12 months

Other Outcomes (1)

• Change in improved labor market / workforce participation and healthcare utilization

  6 months and 12 months

Study Arms (2)

Early Detection (ED)

EXPERIMENTAL

This intervention consists of educational campaigns directed at patients \& families (who have yet to seek care) and professionals in educational and clinical settings to hasten referral of individuals with new onset psychosis to an established, best-practice first-episode service (i.e. STEP). Interleaved with this educational campaign will be procedures to make the STEP clinic more rapidly responsive to referrals to further shorten the duration of untreated psychosis

Behavioral: Early Detection (ED); Behavioral: Usual Detection

Usual Detection

ACTIVE COMPARATOR

This intervention will provide equivalent best practice care without the benefit of an early detection campaign

Behavioral: Usual Detection

Interventions

Early Detection (ED) BEHAVIORAL

This intervention consists of educational campaigns directed at patients \& families (who have yet to seek care) and professionals in educational and clinical settings to hasten referral of individuals with new onset psychosis to an established, best-practice first-episode service (i.e. STEP). Interleaved with this educational campaign will be procedures to make the STEP clinic more rapidly responsive to referrals to further shorten the duration of untreated psychosis

Early Detection (ED)

Usual Detection BEHAVIORAL

This intervention will provide equivalent best practice care without the benefit of an early detection campaign

Early Detection (ED); Usual Detection

Eligibility Criteria

• Age: 16 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• to 35 years old,
• Within first 3 years of psychosis onset (per pre-defined SOS threshold criteria)
• Willing travel to local First Episode Service (STEP, New Haven or PREP, Boston) for treatment;
• Must live in target catchment towns for New Haven site (New Haven, East Haven, West Haven, North Haven, Hamden, Bethany, Orange, Woodbridge, Milford, and Branford) and Boston site (anywhere in Commonwealth of MA)

You may not qualify if:

• Established diagnosis of affective psychotic illness (Bipolar disorder or MDD with psychotic features) or psychosis secondary to substance use or a medical illness
• Unable to communicate in English
• IQ\<70 or eligible for DDS (Department of Developmental Services) care
• legally mandated to enter treatment or otherwise unable to give free, informed consent
• Unable to reliably determine DUP
• Unstable medical illness

Sponsors & Collaborators

• Yale University: lead
• Harvard University: collaborator
• National Institute of Mental Health (NIMH): collaborator

Study Sites (2)

Yale University

New Haven, Connecticut, 06520-8234, United States

Location

Massachusetts Mental Health Center

Boston, Massachusetts, 02115, United States

Location

Related Publications (21)

• Annamalai A, Palmese LB, Chwastiak LA, Srihari VH, Tek C. High rates of obstructive sleep apnea symptoms among patients with schizophrenia. Psychosomatics. 2015 Jan-Feb;56(1):59-66. doi: 10.1016/j.psym.2014.02.009. Epub 2014 Mar 2.

  PMID: 25023923 BACKGROUND

• Tek C, Palmese LB, Krystal AD, Srihari VH, DeGeorge PC, Reutenauer EL, Guloksuz S. The impact of eszopiclone on sleep and cognition in patients with schizophrenia and insomnia: a double-blind, randomized, placebo-controlled trial. Schizophr Res. 2014 Dec;160(1-3):180-5. doi: 10.1016/j.schres.2014.10.002. Epub 2014 Oct 29.

  PMID: 25454802 BACKGROUND

• Tek C, Kucukgoncu S, Guloksuz S, Woods SW, Srihari VH, Annamalai A. Antipsychotic-induced weight gain in first-episode psychosis patients: a meta-analysis of differential effects of antipsychotic medications. Early Interv Psychiatry. 2016 Jun;10(3):193-202. doi: 10.1111/eip.12251. Epub 2015 May 12.

  PMID: 25962699 BACKGROUND

• Kline ER, DeTore NR, Keefe K, Seidman LJ, Srihari VH, Keshavan MS, Guyer M. Development and validation of the client engagement and service use scale: A pilot study. Schizophr Res. 2018 Nov;201:343-346. doi: 10.1016/j.schres.2018.05.006.

  PMID: 29764759 BACKGROUND

• Kline E, Thomas L. Cultural factors in first episode psychosis treatment engagement. Schizophr Res. 2018 May;195:74-75. doi: 10.1016/j.schres.2017.08.035. Epub 2017 Aug 30.

  PMID: 28864280 BACKGROUND

• van Schalkwyk GI, Davidson L, Srihari V. Too Late and Too Little: Narratives of Treatment Disconnect in Early Psychosis. Psychiatr Q. 2015 Dec;86(4):521-32. doi: 10.1007/s11126-015-9348-4.

  PMID: 25663602 BACKGROUND

• Steiner JL, Anez-Nava L, Baranoski M, Cole R, Davidson L, Delphin-Rittmon M, Dike C, DiLeo PJ, Duman RS, Kirk T Jr, Krystal J, Malison RT, Rohrbaugh RM, Sernyak MJ, Srihari V, Styron T, Tebes JK, Woods S, Zonana H, Jacobs SC. The Connecticut Mental Health Center: Celebrating 50 Years of a Successful Partnership Between the State and Yale University. Psychiatr Serv. 2016 Dec 1;67(12):1286-1289. doi: 10.1176/appi.ps.201600373. Epub 2016 Oct 3.

  PMID: 27691379 BACKGROUND

• Foss-Feig JH, Adkinson BD, Ji JL, Yang G, Srihari VH, McPartland JC, Krystal JH, Murray JD, Anticevic A. Searching for Cross-Diagnostic Convergence: Neural Mechanisms Governing Excitation and Inhibition Balance in Schizophrenia and Autism Spectrum Disorders. Biol Psychiatry. 2017 May 15;81(10):848-861. doi: 10.1016/j.biopsych.2017.03.005. Epub 2017 Mar 14.

  PMID: 28434615 BACKGROUND

• Dixon LB, Goldman HH, Srihari VH, Kane JM. Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative. Annu Rev Clin Psychol. 2018 May 7;14:237-258. doi: 10.1146/annurev-clinpsy-050817-084934. Epub 2018 Jan 12.

  PMID: 29328779 BACKGROUND

• Starc M, Murray JD, Santamauro N, Savic A, Diehl C, Cho YT, Srihari V, Morgan PT, Krystal JH, Wang XJ, Repovs G, Anticevic A. Schizophrenia is associated with a pattern of spatial working memory deficits consistent with cortical disinhibition. Schizophr Res. 2017 Mar;181:107-116. doi: 10.1016/j.schres.2016.10.011. Epub 2016 Oct 10.

  PMID: 27745755 BACKGROUND

• Breitborde NJ, Kleinlein P, Srihari VH. Causality Orientations among Individuals with First-Episode Psychosis. Psychosis. 2014 Jun 1;6(2):177-180. doi: 10.1080/17522439.2012.762801.

  PMID: 24976861 BACKGROUND

• Hay RA, Roach BJ, Srihari VH, Woods SW, Ford JM, Mathalon DH. Equivalent mismatch negativity deficits across deviant types in early illness schizophrenia-spectrum patients. Biol Psychol. 2015 Feb;105:130-7. doi: 10.1016/j.biopsycho.2015.01.004. Epub 2015 Jan 17.

  PMID: 25603283 BACKGROUND

• Guloksuz S, Li F, Tek C, Woods SW, McGlashan TH, Friis S, Srihari VH. Analyzing the Duration of Untreated Psychosis: Quantile Regression. JAMA Psychiatry. 2016 Oct 1;73(10):1094-1095. doi: 10.1001/jamapsychiatry.2016.2013. No abstract available.

  PMID: 27580422 BACKGROUND

• Wasser T, Pollard J, Fisk D, Srihari V. First-Episode Psychosis and the Criminal Justice System: Using a Sequential Intercept Framework to Highlight Risks and Opportunities. Psychiatr Serv. 2017 Oct 1;68(10):994-996. doi: 10.1176/appi.ps.201700313. Epub 2017 Sep 1.

  PMID: 28859587 BACKGROUND

• Perez VB, Woods SW, Roach BJ, Ford JM, McGlashan TH, Srihari VH, Mathalon DH. Automatic auditory processing deficits in schizophrenia and clinical high-risk patients: forecasting psychosis risk with mismatch negativity. Biol Psychiatry. 2014 Mar 15;75(6):459-69. doi: 10.1016/j.biopsych.2013.07.038. Epub 2013 Sep 16.

  PMID: 24050720 BACKGROUND

• Srihari VH, Tek C, Pollard J, Zimmet S, Keat J, Cahill JD, Kucukgoncu S, Walsh BC, Li F, Gueorguieva R, Levine N, Mesholam-Gately RI, Friedman-Yakoobian M, Seidman LJ, Keshavan MS, McGlashan TH, Woods SW. Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study. BMC Psychiatry. 2014 Dec 4;14:335. doi: 10.1186/s12888-014-0335-3.

  PMID: 25471062 BACKGROUND

• Srihari VH, Jani A, Gray M. Early Intervention for Psychotic Disorders: Building Population Health Systems. JAMA Psychiatry. 2016 Feb;73(2):101-2. doi: 10.1001/jamapsychiatry.2015.2821. No abstract available.

  PMID: 26747524 BACKGROUND

• Srihari VH. Working toward changing the Duration of Untreated Psychosis (DUP). Schizophr Res. 2018 Mar;193:39-40. doi: 10.1016/j.schres.2017.07.045. Epub 2017 Aug 3. No abstract available.

  PMID: 28779850 BACKGROUND

• Mathis WS, Woods S, Srihari V. Blind Spots: Spatial analytics can identify nonrandom geographic variation in first episode psychosis program enrollments. Early Interv Psychiatry. 2018 Dec;12(6):1229-1234. doi: 10.1111/eip.12681. Epub 2018 Jun 21.

  PMID: 29927083 BACKGROUND

• Kline E, Hendel V, Friedman-Yakoobian M, Mesholam-Gately RI, Findeisen A, Zimmet S, Wojcik JD, Petryshen TL, Woo TW, Goldstein JM, Shenton ME, Keshavan MS, McCarley RW, Seidman LJ. A comparison of neurocognition and functioning in first episode psychosis populations: do research samples reflect the real world? Soc Psychiatry Psychiatr Epidemiol. 2019 Mar;54(3):291-301. doi: 10.1007/s00127-018-1631-x. Epub 2018 Nov 28.

  PMID: 30488086 BACKGROUND

• Ferrara M, Gallagher K, Yoviene Sykes LA, Markovich P, Li F, Pollard JM, Imetovski S, Cahill J, Guloksuz S, Srihari VH. Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative. Psychiatr Serv. 2022 Dec 1;73(12):1416-1419. doi: 10.1176/appi.ps.202100374. Epub 2022 Jun 2.

  PMID: 35652190 DERIVED

MeSH Terms

Conditions

Psychotic Disorders; Schizophrenia

Condition Hierarchy (Ancestors)

Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders

Study Officials

• Vinod Srihari, MD

  Yale University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 20, 2014
• First Posted: February 24, 2014
• Study Start: February 1, 2014
• Primary Completion: February 27, 2020
• Study Completion: August 18, 2020
• Last Updated: April 21, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)