Early Psychosis Prediction and Prevention (EP3)

Increasing attention has been paid to the role of mental illness, specifically psychosis, in large scale acts of violence.  Approximately 100,000 adolescents and young adults have a first psychotic episode each year in the U.S. To address existing research gaps with this high risk population, the NIMH introduced the Early Psychosis Prediction and Prevention (EP3) initiative.  EP3 accelerates research on detecting risk states for psychotic disorders, preventing the onset of psychosis in high risk individuals, and reducing the duration of untreated psychosis in people who have experienced a first psychotic episode.  The initiative addresses public health needs for a psychosis risk prediction tool, preemptive interventions, early detection and intervention, and stage specific specialty care.  The methods to achieve these goals span the research continuum and include biomarker studies, Phase II (Efficacy) and Phase III (Effectiveness) trials, mental health services and dissemination and implementation research.  Several efforts to fill these research gaps have already been launched.  “Research to Improve the Care of Persons at Clinical High Risk for Psychotic Disorders” (RFA-MH-14-210/11/12) aims to support research to inform a step-wise approach to early psychosis intervention in the U.S.  Several hundred published reports have explored the construct of a clinical high risk (CHR) state for psychosis.  Over the past decade, eleven RCTs have been conducted to test the efficacy of psychological, pharmacologic, nutritional, and multi-component psychosocial interventions for preventing psychosis onset among help-seeking persons who meet CHR  criteria.  While groundbreaking, these efficacy trials have not generated knowledge that is readily translatable to clinical practice in U.S. community care settings.  As a result, this funding opportunity will support research to inform a step-wise approach to CHR care in the context of the U.S. healthcare system.   Related, among individuals already experiencing a psychotic episode, meta-analyses demonstrate the correlation the between duration of untreated psychosis (DUP) and poor outcomes.  In the United States, the average DUP (1-3 years) greatly exceeds the international standard (< 3 months).  As result, “Reducing the Duration of Untreated Psychosis in the United States” is a funding opportunity announcement (RFA-MH-13-187/188) with the goal of developing and testing feasible strategies for substantially reducing DUP among persons with first episode psychosis in community settings by removing significant "bottlenecks" in the pathway to care.  Anticipated outcomes and future research directions pertaining to these, and other, EP3 funding initiatives will be reviewed.