APA Registry May Advance Early Detection of Psychosis

A national mental health registry—such as the one under development by APA to help psychiatrists meet quality reporting and Maintenance of Certification (MOC) requirements—may also help to reduce duration of untreated psychosis by enhancing early detection, referral of patients, tracking of symptoms over time, and treatment effects at the psychiatrist, clinic, and national levels.

“In order to achieve this goal, a registry needs to include psychiatrists involved in integrated care arrangements with primary care, and especially the inclusion of health systems that are integrated with educational systems,” said APA Deputy Director of Research Diana E. Clarke, Ph.D., M.Sc. “It may also require interoperability between mental health and primary care registries and be open to modifications as knowledge improves.”

Clarke spoke last month at APA’s fall meeting, IPS: The Mental Health Services Conference, in Washington, D.C. (During the symposium, panelist Carol Tamminga, M.D., was presented with APA’s Research Award. See box.)

Throughout the symposium—and during other lectures and symposia at the IPS—clinicians and researchers emphasized the importance of early detection of psychosis and, especially, the need to shorten the duration of untreated psychosis (DUP) to improve the long-term trajectory of illness. The patient registry being developed by APA may prove to be a critical tool in these efforts.

“Nationally, the registry can allow participating clinicians to track their patients’ symptom profiles and changes in severity over time and easily identify individuals at risk for psychosis by providing measures that indicate presence of psychotic symptoms and biomarkers, such as any lag in neurocognitive development,” Clarke said. “It can also help clinicians monitor prescriptions and medication use. Ideally, the registry can help clinicians engage patients and families in the treatment process.”

APA President-elect Anita Everett, M.D, who was the discussant at the symposium, agreed. “There is growing strength in the evidence that if we can identify high-risk cases early and provide psychosocial support and treatment, we can shorten the duration of untreated mental illness and psychosis, keep a person on track, and ultimately change the trajectory of a person’s life who otherwise might track into a long-term disabling condition such as schizophrenia and severe bipolar disorder,” she said in comments to Psychiatric News following the meeting. “Multiple components are coming together that now support this. These include increasing knowledge about our brain’s plasticity or ability to change biochemically and structurally coupled with the demonstrated value of coordinated specialty care that includes specific interventions such as education coaching, psychotherapy, and pharmacotherapy.

APA began exploring the possibility of creating a patient registry in 2014, and last year the Board of Trustees formally approved a pilot project. In the discussion leading up to that vote, Gregory Dallack, M.D., chair of the APA Registry Work Group, told trustees the registry could help improve health outcomes for patients served by APA members, identify effective patterns of care and best practices on a national basis. A registry can assist members with meeting quality-reporting requirements for Medicare and MOC requirements, he said.

At the IPS symposium, Clarke emphasized the importance of including in the registry integrated care networks that are also integrated with local educational systems, where teachers and school administrators can identify children and adolescents in need of mental health treatment.

Integrated care practice administrators can then register individuals with early symptoms of psychosis and trigger a referral for care when appropriate.

“The registry manager can identify, on an aggregate level, sites with groups of patients with symptoms of psychosis, especially those with no indicated follow-up care,” Clarke said. “And the registry manager can also identify treatments that work or don’t work.” ■