Dont turn your back on the symptoms of psychosis a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK.docVIP

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Dont turn your back on the symptoms of psychosis a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK.doc

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Dont turn your back on the symptoms of psychosis a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK

Connoretal.BMCPsychiatry2013,13:67 /1471-244X/13/67 STUDY PROTOCOL OpenAccess Don’tturnyourbackonthesymptomsof psychosis:aproof-of-principle,quasi-experimental publichealthtrialtoreducethedurationof untreatedpsychosisinBirmingham,UK CharlotteConnor1,2*,MaxBirchwood3,4,ColinPalmer1,SunitaChanna1,NickFreemantle5,HelenLester6, PaulPatterson2,7andSwaranSingh8 Abstract Background:Reducingthedurationofuntreatedpsychosis(DUP)isanaspirationofinternationalguidelinesfor firstepisodepsychosis;however,publichealthinitiativeshavemetwithmixedresults.Systematicreviewssuggest thatgreaterfocusonthesourcesofdelaywithincarepathways,(whichwillvarybetweenhealthcaresettings)is neededtoachievesustainablereductionsinDUP(BJP198:256-263;2011). Methods/Design:Aquasi-experimentaltrial,comparingatargetedinterventionareawitha‘detectionasusual’ areainthesamecity.Aproof-of–principletrial,noaprioriassumptionsaremaderegardingeffectsize;key outcomewillbeanestimateofthepotentialeffectsizeforadefinitivetrial.DUPandnumberofnewcaseswillbe collectedoveran18-monthperiodintargetandcontrolareasandcompared;historicaldataonDUPcollectedin bothareasoverthepreviousthreeyears,willserveasabenchmark.Theinterventionwillfocusonreducingtwo significantDUPcomponentdelayswithintheoverallcarepathway:delayswithinthementalhealthserviceand help-seekingdelay. Discussion:Thispragmatictrialwillbethefirsttotargetknowndelayswithinthecarepathwayforthosewitha firstepisodeofpsychosis.Ifsuccessful,thiswillprovideageneralizablemethodologythatcanbeimplementedina varietyofhealthcarecontextswithdifferingsourcesofdelay. Trialregistration:/ISRCTKeywords:Publicmentalhealthcampaign,First-episodepsychosis,Earlydetection,Durationofuntreatedpsychosis, Youthmentalhealth Background whichDUPexceedsthreemonths,definesacriticalpoint Internationalstudieshaveshownthattheaveragelength after which the likelihood of poorer outcome begins to of time from the onset of psychotic symptoms to first increase, and several studies indicate that ac