Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III).
The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014.



This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment).



Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group.



To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Martin
M
Lambert
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Daniel
D
Schöttle
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Mary
M
Sengutta
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Friederike
F
Ruppelt
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Anja
A
Rohenkohl
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.|Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Daniel
D
Luedecke
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Luise Antonia
LA
Nawara
Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA.
Britta
B
Galling
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Anne-Lena
AL
Falk
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Linus
L
Wittmann
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Vivien
V
Niehaus
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Gizem
G
Sarikaya
Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany.
Ute
U
Handwerk
Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany.
Wiebke
W
Rothländer
University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
Liz
L
Rietschel
Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany.
Charlotte
C
Gagern
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Benjamin
B
Lange
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Christina
C
Meigel-Schleiff
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Dieter
D
Naber
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Michael
M
Schulte-Markwort
Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany.
Helmut
H
Krüger
Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany.
Hans-Peter
HP
Unger
Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany.
Sven
S
Sippel
Center for Mental Health, Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany.
Sabine
S
Ott
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany.
Georg
G
Romer
Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Anne
A
Daubmann
Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Karl
K
Wegscheider
Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA.
Christoph U
CU
Correll
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.|University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
Benno G
BG
Schimmelmann
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Thomas
T
Bock
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Jürgen
J
Gallinat
Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.|Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Anne
A
Karow
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D015331:Cohort Studies; D003156:Community Mental Health Services; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods; D017060:Patient Satisfaction; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D011787:Quality of Health Care; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D018849:Controlled Clinical Trials as Topic
bipolar disorder; early detection; early psychosis; integrated care; schizophrenia