title: McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.
abstract: Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis.
  
  
  
  We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes.
  
  
  
  At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients.
  
  
  
  Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Ann K
authors.initials: AK
authors.lastname: Shinn
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.
authors.forename: Kirsten W
authors.initials: KW
authors.lastname: Bolton
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Karmacharya
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Lewandowski
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Cagri
authors.initials: C
authors.lastname: Yuksel
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Baker
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Virginie-Anne
authors.initials: VA
authors.lastname: Chouinard
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Pingali
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Bye
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Cederbaum
authors.affiliation: McLean OnTrack, Psychotic Disorders Division, McLean Hospital, Boston, MA, USA.|Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Dost
authors.initials: D
authors.lastname: Öngür
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods* / Q000458:organization & administration*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D061345:Early Medical Intervention / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008404:Massachusetts; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D012917:Social Adjustment; D012947:Social Work; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D055815:Young Adult
keywords: dimensional; first episode; psychosis; transdiagnostic; treatment