Tablet-based screening doubles detection of psychotic symptoms in young people

(SACREMENTO)

By asking patients to take a short survey on a tablet before their doctor’s visit, you can help mental health professionals identify young people at risk of psychosis. A UC Davis Health study found that when patients completed a 21-question pre-survey, twice as many people were at risk of psychosis compared to those who did not complete the survey.

But despite improved identification of at-risk individuals, technology-based screening has not shortened the time between the onset of participants’ first psychotic symptoms and the start of treatment.

The results are presented in a new UC Davis Health study published in JAMA Psychiatry.

Previous studies have shown that the longer the time between the first psychotic episode, such as hallucinations or delusions, and the start of treatment, the more severe the illness. According to the National Institute of Mental Health, psychosis often begins when a person is in their late teens through their twenties. Approximately 100,000 new cases of psychosis are diagnosed each year in the United States.

“Adding a brief screening to the initial assessment can make a big difference in clinical decision making, helping you understand that a person needs specialized care,” said Tara A. Niendam, first author of the study. Niendam is Professor and Executive Director of the Early Psychosis Program at the University of California, Davis.

Three people are standing in the corridor and smiling at the camera.  An elderly man with white hair in a blue suit stands on the left, a taller young man with brown hair in a brick-colored button-down shirt stands in the middle, and a woman with ear-length gray hair in a black dress and on the right stands a gray plaid open-front sweater.
Left to right: A new study by Cameron S. Carter, Mark Saville, and Tara A. Niendam focuses on identifying early psychosis.

Methods

The data came from ten community clinics and four school sites in California. Centers were divided into those that used screening plates (“active screening”) and those that screened using clinical judgment (“treatment as usual”).

On sites with active screening, people aged 12 to 30 filled out a questionnaire on a tablet before visiting a mental health provider.

Known as the PQ-B (Prodrome Questionnaire, Short Version), the questions included: “Does your familiar environment sometimes feel strange, confusing, threatening, or unrealistic?” and “Have you seen things that other people don’t see or don’t seem to see?”

If the score on the questionnaire was 20 or higher, 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 referral to early psychosis clinics.

Results

The researchers evaluated data from 2,432 people in active screening centers and 2,455 people in conventional treatment centers.

Active screening centers reported a significantly higher detection rate for psychotic spectrum disorders: 136 cases (5.6%) compared to 65 (2.6%) in centers where no tablet screening was performed.

Active screening centers also referred 13 people with a first episode of psychosis, compared with four in centers where active screening was not used.

But despite early detection, the data did not show a statistically significant difference in the duration of untreated psychosis. The mean for the active screening group was 239 days. The mean value was 262.3 for the conventional treatment group.

The researchers noted that this was likely due to several factors that led to the delay in access to the mental health system in the US.

“On average, our participants suffered from untreated psychosis for approximately six months before presenting to one of our participating clinics,” said Mark Saville, assistant professor of psychiatry and behavioral sciences and co-author of the study. “A multifaceted approach to support people to seek help more quickly and improve pathways to appropriate services after they seek help may be necessary to achieve a significant reduction in the duration of untreated psychosis.”

Young people at risk are not identified

Twenty-four sites agreed to participate. However, only ten community clinics and four school districts were able to fully screen. Some study sites, such as primary health care clinics, have had problems with screening and providing feedback; schools struggled with staffing issues and parental involvement.

The setbacks highlight some of the challenges that can be faced when scaling up programs that offer active screening. But the results show how many young people at risk of psychosis do not identify with the current system.

“Prior to this study, there had been no systematic population screening for psychosis in the United States,” said Cameron S. Carter, senior author on the paper. Carter is Distinguished Professor of Psychiatry and Psychology and Director of the UC Davis Medical Imaging Research Center and the Center for Excellence in Behavioral Health.

“Our more frequent case identification using the PQ-B questionnaire is an important finding. More people from this active group are getting help,” Carter said. “This is important because we know from previous studies that people who are detected and treated at the earliest stages of the disease are most likely to have the best outcomes.”

If you or a loved one suspects you may have symptoms of psychosis, the Early Psychosis Program at UC Davis Health offers a free online questionnaire.

Additional study authors include Tyler A. Lesh, Daniel Ragland, Halima Bolden, Hayley Skimba, Sarah Gobrial, Monet Meyer, Katherine Pierce, Adi Rosenthal, Taylor Fedechko, Laura Tully, Valerie Tryon, Rosemary Kress, and Richard Kravitz of UC Davis; Rachel Loewy and Kevin DeLucchi of the University of California, San Francisco; and Howard Goldman of the University of Maryland, Baltimore.

Funding for this study was provided by grants from the National Institute of Mental Health (5R01MH104235) and (5T32MH018261-35).

Resources

Content Source

California Press News – Latest News:
Los Angeles Local News || Bay Area Local News || California News || Lifestyle News || National news || Travel News || Health News

Related Articles

Back to top button