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Technology-Enhanced Screening Identifies Twice as Many People With Psychosis Disorders
Population-based screening using technology identified twice the number of patients with psychosis spectrum disorders compared to clinical judgment but did not reduce the duration of untreated psychosis (DUP), according to a cluster randomized clinical trial published in JAMA Psychiatry.
“This study suggests that population-based electronic screening for early psychosis in [community mental health clinics (CMHCs)] is an effective strategy to increase the number of appropriate referrals to specialty early-psychosis clinics,” study authors noted. “The intervention also significantly increases the proportion of referred individuals who meet the WHO-recommended maximum DUP of 90 days, indicating this may represent an effective method to hasten the pathway to care for at least a subset of clients.”
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Participants presented for mental health services at 24 community sites and ranged in age from 12 to 30 years. Of those sites, 12 received treatment as usual (TAU) as a control group, and the other 12 served as the active screening group. Patients in the active screening group completed the Prodromal Questionnaire–Brief using tablets at intake, and those scores were used in conjunction with clinical judgment for referrals. Those in the TAU group were referred based on clinical judgment alone.
In total, there were 2432 participants in the active screening group and 2455 in the TAU group. The active screening sites reported a higher detection rate of psychosis spectrum disorders—5.6% of participants versus 2.6% at the TAU sites. The active group also referred more individuals with first-episode psychosis (FEP)—1.9% versus 1.2% in the TAU group—and DUPs less than 90 days.
“Building on recent successful combined strategies, we recommend adding population screening to community education, stigma reduction, and improved pathways to care online, in conjunction with the broadening of insurance coverage and interventions designed to facilitate full engagement in specialty treatment,” authors concluded. “This may be a more effective and comprehensive solution to reduce DUP overall and thus improve long-term client outcomes.”
