A critical development in recent years has been the enormous growth of internet and social media utilization, particularly among young people. We are proposing to conduct three integrated, exploratory/developmental projects utilizing internet and social media directed towards reducing the duration of untreated psychosis (DUP). Approximately 100,000 adolescents and young adults in the U.S. experience a first episode of psychosis (FEP) every year. Despite symptom severity and declines in functioning, the time between symptom onset and receiving appropriate care in the U.S. is on average 2 years. Data from our ongoing NIMH-funded Recovery After an Initial Schizophrenia Episode (RAISE) project, being conducted at 34 clinics across the U.S. involving 404 FEP patients, indicate a median duration of untreated psychosis (DUP) of 74 weeks. The North American Prodrome Longitudinal Study (NAPLS) shows a similar period (i.e., 2 years) during which emerging attenuated symptoms develop into full-blown psychosis (the prodromal period). Thus, for many young people with emerging psychotic disorders, the total period of active (attenuated plus full-blown) symptoms before initiation of treatment may be 4 years on average;furthermore, their "pathways to care" are often less than ideal. Longer DUP has been shown to independently predict more hospital readmissions, greater symptom severity and poorer quality of life. Results from the proposed projects will provide novel information that is critical for establishing internet/social media means of outreach and engagement, which can be leveraged to identify and refer patients with either prodromal (attenuated positive) symptoms or signs and symptoms of FEP for timely, specialized treatment. These projects will establish the acceptability and feasibility of specific approaches: (1) We will refine an interview that is the first to document hw the internet and social media were utilized during, and in response to, the evolution of each young person's psychotic or attenuated psychotic symptoms. This will provide critical information identifying potential points of intervention and how to utilize the internet/social meda in a clinical study to improve pathways to care and help steer patients into treatment in a more timely fashion. (2) We will test the feasibility of using an e-survey instrument with college students, which can provide anonymous self-assessment for early signs of psychosis, with linkages to educational websites and referrals to established first-episode programs for those who score above a specified threshold. (3) We will also work with teams of students at two of the top public and private high schools in New York City to engage them in competing for prizes for developing promising internet and social media strategies to identify youth at high risk of psychosis or with FEP and link them to treatment. The students will also advise us on other aspects of the project. All of this work is designed with the goal of developing and refining strategies to be used in the conduct of subsequent, large-scale studies intended to demonstrate our ability to significantly reduce DUP in the U.S. via internet and social media strategies.
There is compelling evidence that the longer incipient psychoses go untreated, the poorer the outcome on many levels. We are proposing to develop innovative strategies employing internet and social media to facilitate help-seeking, access and engagement in care for persons with first episode psychoses and/or youth at high risk for psychosis. The data from this project will inform the design and conduct of large-scale clinical trials intended to reduce the inappropriately high duration of untreated psychosis in the US.