Resilience Evaluation-Social Emotional Training (RE-SET) at Massachusetts General Hospital (MGH): Establishing a Clinical High Risk for Psychosis Program from the Ground Up

Jacqueline Clauss, MD, PhD (1,2), Lauren Utter, PsyD, Drew Coman, PhD (1,2), Michaela Newton, MA (1,3), Abigail Donovan, MD (1,2), Daphne Holt, MD, PhD (1,2)

1. Department of Psychiatry, MGH, Boston, MA
2. Harvard Medical School, Boston, MA,
3. William James College, Newton, MA

Abstract

Background: Individuals are identified as being at clinical high risk for psychosis (CHR-P) based on the presence of brief or attenuated psychotic symptoms. These individuals are typically adolescents or young adults and many of them also struggle with comorbid diagnoses, such as major depression, anxiety disorders, PTSD, and autism spectrum disorder.

Methods: The RE-SET program at MGH was established in 2021 to provide early identification, treatment, and ongoing research in CHR-P. Potential clients between the ages of 12-30 were evaluated. Prior to initial diagnostic evaluation with a psychiatrist, potential clients completed a series of measures to describe their symptoms, including the Prodromal Questionnaire-Brief (PQ-B), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory-II (BDI-II). Following initial diagnostic evaluation, if there was concern for attenuated or brief psychotic symptoms, clients completed the Structured Interview for Psychosis-Risk Syndromes with a clinical psychologist. Finally, clients, client’s family, and their current treaters if available, were provided feedback from the evaluation and recommendations for further treatment.

Results: RE-SET received 68 referrals in its first year of operation, 29 clients were seen for initial evaluation, and eight clients were enrolled in ongoing care. Clients were on average 18.2y (range: 13.6 – 25.3) at the time of initial evaluation. On average, clients seen for initial evaluation endorsed 8.9 psychotic-like experiences on the PQ-B (SD: 6.6, out of 21 possible), had moderate depression symptoms as measured by the BDI-II (mean + SD: 21.9 + 16.2), and severe anxiety symptoms as measured by the STAI (mean + SD: 44.3 + 10.0).

Conclusions: MGH has established a new CHR-P program for early identification, treatment, and ongoing research. As has been reported elsewhere, clients present with significantly elevated symptoms in multiple domains. They benefit from tailored psychiatric interventions sometimes most appropriately provided within a CHR-P program or other forms of ongoing specialized care.