The primary aim of this application is to conduct a randomized, controlled clinical trial of a specialized mental health service delivery system specifically developed for prodromal psychotic disorders. The intervention is Family-aided Assertive Community Treatment (FACT). The proposed study will be part of a larger program, Portland Identification and Early Referral (PIER), under foundation and Center for Mental Health Center sponsorship, that has established a population-based system of early detection for Greater Portland, Maine. Previous and present effort has educated and trained the community-at-large and all health, education and other professionals, with the result that referrals are occurring at the expected frequency. The principle strategy is to intervene early, prior to onset, in the course of the onset of psychotic disorders to arrest the development of psychotic symptoms and functional disability. The test treatment is a specialized combination of psychoeducational multifamily group and assertive community treatment. In pilot studies FACT has led to very low rates of conversion to psychosis and very high rates of engagement and retention in treatment, thereby decreasing the burden on the family and the community. The goal of the treatment is prevention of psychosis and disability. ? ? This study will assess experimentally the clinical effectiveness of this new type of mental health service. Other domains of outcome include cognitive dysfunction and functional disability. The project will support an EDIPFACT team of clinical staff with the ability to: a. foster detection of prodromal disorders in the Greater Portland community by general practitioners, guidance counselors, mental health professionals and the general public; b. accurately assess individuals at high risk for psychosis; c. reliably deliver an evidence-based psychosocial and, if indicated, pharmacological treatment package using standardized methodology. The research study will test, in a randomized controlled trial, the symptomatic and functional outcome of treatment in 96 subjects ages 12 to 35 identified by that system. It will allow the analysis of key social factors contributing to psychosis and their interaction with the treatment conditions and each other. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH065367-05
Application #
7232627
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Juliano-Bult, Denise M
Project Start
2003-03-01
Project End
2010-01-31
Budget Start
2007-02-01
Budget End
2010-01-31
Support Year
5
Fiscal Year
2007
Total Cost
$872,264
Indirect Cost
Name
Maine Medical Center
Department
Type
DUNS #
071732663
City
Portland
State
ME
Country
United States
Zip Code
04102
McFarlane, William R; Susser, Ezra; McCleary, Richard et al. (2014) Reduction in incidence of hospitalizations for psychotic episodes through early identification and intervention. Psychiatr Serv 65:1194-200
Woodberry, Kristen A; McFarlane, William R; Giuliano, Anthony J et al. (2013) Change in neuropsychological functioning over one year in youth at clinical high risk for psychosis. Schizophr Res 146:87-94
McFarlane, William R (2011) Prevention of the first episode of psychosis. Psychiatr Clin North Am 34:95-107
Woodberry, Kristen A; Seidman, Larry J; Giuliano, Anthony J et al. (2010) Neuropsychological profiles in individuals at clinical high risk for psychosis: relationship to psychosis and intelligence. Schizophr Res 123:188-98
McFarlane, William R; Cook, William L; Downing, Donna et al. (2010) Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis. Psychiatr Serv 61:512-5
McFarlane, William R; Cook, William L (2007) Family expressed emotion prior to onset of psychosis. Fam Process 46:185-97