Maryland Undertakes Ambitious Effort at Early ID of Psychosis

The University of Maryland Department of Psychiatry has received $1.2 million from the state of Maryland to begin an ambitious statewide initiative aimed at early intervention and treatment of individuals at clinical high risk for mental illness with psychosis and those with first-episode schizophrenia and related disorders.

The Maryland Early Intervention Program (EIP) is a collaboration among several centers and divisions within the University of Maryland School of Medicine Department of Psychiatry. These include the Maryland Psychiatric Research Center (MPRC); the divisions of Child and Adolescent Psychiatry, Community Psychiatry, Psychology, and Psychiatric Services Research; and the University of Maryland Baltimore County Department of Psychology, all of which have extensive experience providing clinical services in Maryland, evaluating novel therapeutics for people with treatment-resistant schizophrenia, implementing statewide program evaluation relating to serious mental illness in youth, and providing consultation services for adverse effects of first- and second-generation antipsychotic drugs.

In an interview with Psychiatric News, Robert Buchanan, M.D., of the MPRC, said that at the outset, core personnel and facilities will be provided through the Department of Psychiatry and UMBC Department of Psychology. “Over time, we will develop a comprehensive, statewide program, with clinical services provided both by these UM centers and divisions, as well as by satellite sites across the state,” he said.

For this reason, the Maryland initiative represents one of the most ambitious among a growing number of projects in North America, Europe, and Australia to move toward identification of patients in the “prodromal,” pre-clinical stages of the disorder and toward rapid treatment of those in the early stages of a first episode.

Buchanan said a motivating factor behind Maryland Gov. Martin O’Malley’s support of the initiative was publicity surrounding incidents of gun violence, especially the December 2012 shooting at an elementary school in Newtown, Conn. “The first award of money came through the governor’s supplemental budget, and in large part the impetus for this initiative was the Newtown shooting,” Buchanan said. “In the wake of the shooting, the governor asked the Department of Health, `What are we going to do about this?’ and the secretary in turn asked the state Department of Mental Health and Hygiene to develop a request for proposals.

“At the Department of Psychiatry at the University of Maryland, we were already working on a program around early detection and intervention for people at clinical high risk for mental illness with psychosis and for people in the early stages of a first episode of schizophrenia. So we took this initiative and modified it for the specific needs of the state.”

The proposal was submitted to the department and later approved by the governor and the legislature this past spring, he said.

The initiative includes several interconnected components: outreach and education to help identify individuals at clinical high risk for psychosis; a treatment program for first-episode psychosis; development of a call-in consultation service as a way to reach out to more distant parts of the state, for instance in western Maryland and on the Eastern Shore; and training of clinicians around the state to disseminate the tools for early intervention and first-episode services.

“Our first episode clinic at MPRC has been around for 15 years and has given us broad experience in working with this population,” Buchanan said. “We are going to be increasing the number of services we provide and expanding the capacity of this clinic, as well as our specialized clinic in downtown Baltimore. Our hope is that as we do the outreach and education, that will increase the detection of people who are at risk, which will then lead to increased referrals.”

He added, “We are very excited about this effort. There are certain elements that we think are unique to this initiative. Other locations around the country have developed specialized services for people with first-episode schizophrenia. And there are other locations that have programs for people at clinical high risk for mental illness with psychosis. What is unique about our effort is that we are trying to do this in an integrated way and develop a system that will eventually serve the whole state.” ■