MSGID: 1:317/3 63f448ee   
   PID: hpt/lnx 1.9.0-cur 2019-01-08   
   TID: hpt/lnx 1.9.0-cur 2019-01-08   
    Tablet-based screening doubles detection of psychosis symptoms in youth   
      
      
     Date:   
         February 20, 2023   
     Source:   
         University of California - Davis Health   
     Summary:   
         Asking patients to take a short survey on a tablet before their   
         appointments may help mental health providers identify young   
         people at risk of psychosis. A study found that when patients   
         took a 21-question pre-visit survey, more than twice as many were   
         identified at risk of psychosis compared to those who did not   
         complete the survey. According to the National Institute of Mental   
         Health, psychosis often begins when a person is in his or her late   
         teens to mid-twenties. About 100,000 new cases of psychosis are   
         diagnosed each year in the U.S.   
      
      
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   FULL STORY   
   ==========================================================================   
   Asking patients to take a short survey on a tablet before their   
   appointments may help mental health providers identify young people at   
   risk of psychosis. A UC Davis Health study found that when patients took   
   a 21-question pre-visit survey, more than twice as many were identified   
   at risk of psychosis compared to those who did not complete the survey.   
      
      
   ==========================================================================   
   But despite the improvement in detecting individuals at risk, the   
   technology- based screening did not reduce the time between the   
   participants' first psychotic symptoms and when they received treatment.   
      
   The findings are in a new UC Davis Health study published in JAMA   
   Psychiatry.   
      
   Previous studies have shown that the longer the time between the first   
   psychotic incident -- such as hallucinations or delusions -- and receiving   
   treatment, the more severe the course of the disease. According to the   
   National Institute of Mental Health, psychosis often begins when a person   
   is in his or her late teens to mid-twenties. About 100,000 new cases of   
   psychosis are diagnosed each year in the U.S.   
      
   "The addition of a brief screener at the initial evaluation can make a   
   dramatic difference in clinical decision-making, helping you to realize   
   that an individual needs specialized care," said Tara A. Niendam, first   
   author of the study. Niendam is a professor and executive director of   
   the UC Davis Health Early Psychosis Programs.   
      
   Methods Data came from ten community clinics and four school sites. Sites   
   were divided by those that used tablets for screening ("active screening")   
   and those that screened using clinical judgment ("treatment as usual").   
      
   For the sites with active screening, individuals between the ages of 12   
   and 30 completed a questionnaire on a tablet before their visit with a   
   mental health care provider.   
      
   Known as the PQ-B (Prodromal Questionnaire, Brief Version), questions   
   included "Do familiar surroundings sometimes seem strange, confusing,   
   threatening or unreal to you?" and "Have you seen things that other   
   people can't see or don't seem to see?"  If the questionnaire score was   
   20 or above, the participant was offered a referral to an early psychosis   
   clinic for further evaluation.   
      
   Sites not using active screening relied on clinical judgment for further   
   evaluation and referrals to early psychosis clinics.   
      
   Results The researchers evaluated data from 2,432 individuals at the   
   active-screening sites and 2,455 at the treatment-as-usual sites.   
      
   Active-screening sites reported a significantly higher detection rate   
   of psychosis spectrum disorders, with 136 cases (5.6%), compared to 65   
   (2.6%) in the sites that did not use the tablet screening.   
      
   The active-screening sites also referred 13 individuals with first-episode   
   psychosis compared to four in the sites that did not use active screening.   
      
   But despite the early detection, the data showed no statistically   
   significant difference in the duration of untreated psychosis. The mean   
   for the active screening group was 239 days. The mean was 262.3 for the   
   treatment-as-usual group.   
      
   The researchers noted this was likely due to multiple factors leading   
   to delayed access to the mental health system in the U.S.   
      
   "On average, our participants experienced untreated psychosis for   
   approximately six months before presenting at one of our participating   
   clinic sites," said Mark Savill, assistant professor in the Department   
   of Psychiatry and Behavioral Sciences and a co-author of the study. "A   
   multifaceted approach that focuses on supporting individuals to seek   
   help quicker and improving the pathway to appropriate services once they   
   present for care may be necessary to achieve meaningful reductions in   
   the duration of untreated psychosis."  Young people at risk are not   
   being identified Twenty-four sites agreed to participate. However,   
   only ten community clinics and four school sites were able to fully   
   implement the screening. Some study sites, such as primary care clinics,   
   faced challenges implementing the screenings and reporting feedback;   
   schools struggled with staffing issues and parent engagement.   
      
   The setbacks highlight some of the challenges that might be faced scaling   
   up programs that offer the active screening. But the results highlight   
   how many young people at risk of psychosis are not being identified with   
   the current system.   
      
   "Population-based screening for psychosis has not been addressed   
   systematically in the U.S. prior to this study," said Cameron S. Carter,   
   senior author of the paper. Carter is a distinguished professor of   
   psychiatry and psychology and director of the UC Davis Health Imaging   
   Research Center and the Behavioral Health Center for Excellence.   
      
   "Our increased identification of cases using the PQ-B questionnaire   
   is an important finding. More people in this active group are getting   
   into care," Carter said. "That's important because we know from previous   
   research that individuals who are identified and receive treatment at the   
   very early stages in their illness are likely to have the best outcomes."   
   If you or a loved one think you may be experiencing symptoms of psychosis,   
   the Early Psychosis Programs at UC Davis Health offer a free online   
   screening survey.   
      
   Additional authors on the study includeTyler A. Lesh, Daniel Ragland,   
   Khalima Bolden, Haley Skymba, Sarah Gobrial, Monet Meyer, Katherine   
   Pierce, Adi Rosenthal, Taylor Fedechko, Laura Tully, Valerie Tryon,   
   Rosemary Cress and Richard Kravitz from UC Davis; Rachel Loewy and Kevin   
   Delucchi from UCSF; and Howard Goldman from University of Maryland,   
   Baltimore.   
      
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   ==========================================================================   
   Story Source: Materials provided by   
   University_of_California_-_Davis_Health. Original written by Lisa   
   Howard. Note: Content may be edited for style and length.   
      
      
   ==========================================================================   
   Journal Reference:   
      1. Tara A. Niendam, Rachel Loewy, Mark Savill, Kevin L. Delucchi,   
      Tyler A.   
      
         Lesh, J. Daniel Ragland, Khalima Bolden, Haley V. Skymba, Sarah   
         Gobrial, Monet S. Meyer, Katherine M. Pierce, Adi Rosenthal, Taylor   
         L. Fedechko, Laura M. Tully, Valerie L. Tryon, Howard Goldman,   
         Rosemary D. Cress, Richard L. Kravitz, Cameron S. Carter. Effect   
         of Technology-Enhanced Screening in Addition to Standard Targeted   
         Clinician Education on the Duration of Untreated Psychosis. JAMA   
         Psychiatry, 2023; 80 (2): 119 DOI: 10.1001/jamapsychiatry.2022.4436   
   ==========================================================================   
      
   Link to news story:   
   https://www.sciencedaily.com/releases/2023/02/230220121906.htm   
      
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