Schizophrenia Research最新文献

{"title":"HONE: A learning health system platform for advancing early intervention in first episode psychosis","authors":"Walter S. Mathis,&nbsp;Toni Gibbs-Dean,&nbsp;John D. Cahill,&nbsp;Vinod H. Srihari","doi":"10.1016/j.schres.2025.04.009","DOIUrl":"10.1016/j.schres.2025.04.009","url":null,"abstract":"<div><div>The emergence of psychosis in early adulthood necessitates rapid, specialized care to improve outcomes and reduce the duration of untreated psychosis. Early intervention services (EIS) for First Episode Psychosis (FEP) are exemplars of healthcare reform but face challenges in sustaining durable improvements across patients' lifetime illnesses. Learning Health Systems (LHS) present a transformative framework, integrating care delivery with continuous quality improvement and research. In this paper, we detail the development and evolution of the Health Outcomes Network and Education (HONE), a novel informatics platform designed to support an LHS for FEP.</div><div>HONE facilitates data harmonization, analytics, and visualization to drive quality improvement, leveraging user-centered design to engage clinicians and align with clinical workflows. The platform emphasizes evidence-based outcomes, integrating diverse data sources, including patient-reported outcomes, clinical assessments, and external datasets, within a harmonized repository. By employing a minimalist, question-based approach to data visualization, HONE delivers actionable insights that inform clinical practice while generating research questions to improve care.</div><div>We discuss key lessons from HONE's development, including the importance of user engagement, iterative refinement, and balancing standardization with site-specific flexibility. HONE has been successfully deployed across multi-site networks, demonstrating its scalability and adaptability to diverse healthcare settings. This paper highlights HONE's contributions to bridging the gap between knowledge and care, fostering bi-directional knowledge translation, and advancing mental health outcomes. Future efforts will focus on expanding HONE's reach, integrating predictive analytics, and evaluating its long-term impact on FEP care within the LHS framework.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"280 ","pages":"Pages 1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single composite index of semantic behavior tracks symptoms of psychosis over time","authors":"Claudio Palominos ,&nbsp;Maryia Kirdun ,&nbsp;Amir H. Nikzad ,&nbsp;Michael J. Spilka ,&nbsp;Philipp Homan ,&nbsp;Iris E. Sommer ,&nbsp;Sunny X. Tang ,&nbsp;Wolfram Hinzen","doi":"10.1016/j.schres.2025.03.038","DOIUrl":"10.1016/j.schres.2025.03.038","url":null,"abstract":"<div><div>Semantic variables automatically extracted from spontaneous speech characterize anomalous semantic associations generated by groups with schizophrenia spectrum disorders (SSD). However, with the use of different language models and numerous aspects of semantic associations that could be tracked, the semantic space has become very high-dimensional, challenging both theoretical understanding and practical applications. This study aimed to summarize this space into a single composite semantic index and to test whether it can track diagnosis and symptom profiles over time at an individual level. The index was derived from a principal component analysis (PCA) yielding a linear combination of 117 semantic variables. It was tested in discourse samples of English speakers performing a picture description task, involving a total of 103 individuals with SSD and 36 healthy controls (HC) compared across four time points. Results showed that the index distinguished between SSD and HC groups, identified transitions from acute psychosis to remission and stabilization, predicted the sum of scores of the Thought, Language and Communication (TLC) index as well as subscores, capturing 65 % of the variance in the sum of TLC scores. These findings show that a single indicator meaningfully summarizes a shift in semantic associations in psychosis and tracks symptoms over time, while also pointing to variance unexplained, which is likely covered by other semantic and non-semantic factors.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 116-127"},"PeriodicalIF":3.6,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Psychopathology trajectories and relapse in first episode schizophrenia with assured long-acting injectable adherence over 24 months\" [Schizophr. Res. volume 276 (2025), 8-14/article number].","authors":"Smit Retha, Luckhoff Hilmar, Phahladira Lebogang, Kilian Sanja, Emsley Robin, Asmal Laila","doi":"10.1016/j.schres.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.schres.2025.04.005","url":null,"abstract":"","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom networks of psychotic experiences and functional somatic symptoms in adolescence: A cross-sectional study of two population-based cohorts","authors":"Martin Køster Rimvall ,&nbsp;Spyros Balafas ,&nbsp;Charlotte Ulrikka Rask ,&nbsp;Ernst C. Wit ,&nbsp;Judith G.M. Rosmalen ,&nbsp;Frank Verhulst ,&nbsp;Jim van Os ,&nbsp;Johanna T.W. Wigman ,&nbsp;Pia Jeppesen","doi":"10.1016/j.schres.2025.03.037","DOIUrl":"10.1016/j.schres.2025.03.037","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary theoretical models underlying development of psychotic- and functional disorders show similarities, including attribution of aberrant salience to everyday (bodily) sensations and an increased tendency of top-down generation of perception. In two general population samples of adolescents, we aimed to examine potential associations between subclinical phenomena, namely functional somatic symptoms (FSS) and psychotic experiences (PE).</div></div><div><h3>Methods</h3><div>We used data from two cohorts of adolescents aged 15–17 years: the Copenhagen Child Cohort 2000 (Denmark, <em>n</em> = 2550) and the TRacking Adolescents' Individual Lives Survey (the Netherlands, <em>n</em> = 1665). We identified comparable self-reported symptoms of FSS and PE respectively in each cohort. The cohort data were analyzed separately to enable replication, and mixed graphical models were used to estimate symptom networks. First, networks including only FSS and PE were modelled. Second, an emotional symptom score was included in the networks.</div></div><div><h3>Results</h3><div>While numerous specific symptom-to-symptom cross-domain associations were not replicated, symptom networks of the two cohorts overall showed relatively comparable patterns. Delusions of persecution showed the strongest connection with FSS in both cohorts. In the models including emotional symptoms, emotional problems were associated with many PE and FSS, but did not fundamentally change the structure of the original networks.</div></div><div><h3>Conclusion</h3><div>Using a symptom-based approach the current study lent little support to the notion of specific associations between PE and FSS, yet associations between FSS and PE in adolescence were found in both cohorts. The associations between the two domains could not be fully explained by shared associations with emotional problems.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 128-136"},"PeriodicalIF":3.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum bilirubin and type 2 diabetes mellitus risk: Findings from a schizophrenia cohort","authors":"Kuan Liu ,&nbsp;Hao-Wen Chen ,&nbsp;Shi-Ao Wang ,&nbsp;Chen-Yu Zhang ,&nbsp;Bi-Fei Cao ,&nbsp;Xiao-Chun Zhang ,&nbsp;Shan-Yuan Gu ,&nbsp;Qi Zhong ,&nbsp;Yan-Fei Wei ,&nbsp;Yong-Qi Liang ,&nbsp;Wei-Dong Fan ,&nbsp;Zheng-Yun Xu ,&nbsp;Kai-Yue Liao ,&nbsp;Zi-Xuan Zhao ,&nbsp;Xian-Bo Wu","doi":"10.1016/j.schres.2025.03.039","DOIUrl":"10.1016/j.schres.2025.03.039","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between serum bilirubin levels and type 2 diabetes mellitus (T2DM) in individuals with schizophrenia (SCZ) remains poorly understood. This study investigated associations between total, conjugated, and unconjugated bilirubin (TB, CB, and UCB) and T2DM risk, while exploring the potential role of inflammatory pathways.</div></div><div><h3>Methods</h3><div>The study included 862 SCZ patients from Baiyun Jingkang Hospital, Guangzhou, the People's Republic of China. Cox proportional hazards model assessed baseline bilirubin and T2DM risk, while causal mediation analysis explored inflammatory markers. Latent class trajectory model and logistic regression model evaluated the association between multi-timepoint trajectories of bilirubin and T2DM prevalence.</div></div><div><h3>Results</h3><div>Over a median 3.19-year follow-up, 63 T2DM cases were diagnosed. Adjusted hazard ratios per 1 μmol/L increase were 0.88 (95 % CI: 0.82–0.95) for TB, 0.71 (0.57–0.89) for CB, and 0.86 (0.78–0.95) for UCB. Compared to the lowest tertile, the highest tertiles of TB, CB, and UCB were associated with 63 %, 74 %, and 63 % reduced T2DM risks, respectively. Lymphocyte count mediated TB (8.77 %), CB (11.68 %), and UCB (8.34 %); CRP mediated TB (3.33 %) and UCB (4.60 %) with T2DM. Persistently high TB and UCB levels were associated with lower T2DM prevalence (OR = 0.22 and 0.30, respectively).</div></div><div><h3>Conclusion</h3><div>Elevated bilirubin levels are associated with reduced T2DM risk in SCZ patients, with lymphocyte count and CRP partially mediating the bilirubin-T2DM relationship. And persistently high levels of TB and UCB linked to a lower prevalence of T2DM. These findings suggest that moderately elevated serum bilirubin may reduce T2DM risk among SCZ patients.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 106-115"},"PeriodicalIF":3.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blink rates in patients with schizophrenia compared to healthy controls: A meta-analysis","authors":"Johannes Reinau Windelborg Nielsen ,&nbsp;Martin Dietz ,&nbsp;Oskar Hougaard Jefsen","doi":"10.1016/j.schres.2025.03.019","DOIUrl":"10.1016/j.schres.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Eyeblink rates vary with cognitive states and may reflect dopaminergic activity. Early reports have found elevated blink rates in schizophrenia, potentially linked to hyperdopaminergia, but findings have been inconsistent. We performed a systematic review and meta-analysis of blink rates in patients with schizophrenia compared to healthy controls and the impact of medication.</div></div><div><h3>Methods</h3><div>We registered a protocol for the review on PROSPERO. We searched PubMed, SCOPUS, and Embase, performed title- and abstract-screening, full-text screening, data extraction, and risk-of-bias assessment. We calculated meta-level effect sizes, assessed effect size heterogeneity, and tested for small-study effects.</div></div><div><h3>Results</h3><div>We included 22 studies in the systematic review, of which 19 were included in the meta-analysis, comprising 632 patients and 791 healthy controls. Most studies had a high risk of bias, primarily due to lack of blinding and confounding by medication. Meta-analysis revealed an elevated blink rate in patients with schizophrenia compared to healthy controls (Hedges' <em>g</em> = 0.48; 95 % CI [0.13,0.82]). Stratified meta-analyses revealed elevated blink rates in unmedicated patients with schizophrenia compared with healthy controls (Hedges' <em>g</em> = 0.83; 95 % CI [0.34, 1.31]), but not in medicated patients compared with controls (Hedges' <em>g</em> = −0.09; 95 % CI [−0.64, 0.46]).</div></div><div><h3>Conclusion</h3><div>Blink rates are elevated in unmedicated patients with schizophrenia, but not medicated patients compared to healthy controls. These findings underscore further research of the link between blink rates, central dopamine, and schizophrenia.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 87-93"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in fatty acid metabolism in patients with schizophrenia in a multi-omics perspective","authors":"Long Chen ,&nbsp;Zhiqiang Wang ,&nbsp;Yanyu Wang ,&nbsp;Haonan Jiang ,&nbsp;Yuntong Ding ,&nbsp;Qingrong Xia ,&nbsp;Xialong Cheng ,&nbsp;Xulai Zhang","doi":"10.1016/j.schres.2025.03.036","DOIUrl":"10.1016/j.schres.2025.03.036","url":null,"abstract":"<div><h3>Background</h3><div>Recent research has extensively explored the involvement of gut microbes in various fatty acid metabolic processes, elucidating their crucial roles in host energy homeostasis and metabolism. Nevertheless, there remains a dearth of studies examining the comprehensive profile of fatty acid metabolites in schizophrenia and their potential connection to gut microbes.</div></div><div><h3>Method</h3><div>Conducting a thorough investigation, this study scrutinized the gut microbiome composition of 63 individuals, consisting of 35 schizophrenia (SZ) patients and 28 demographically matched healthy control (HC) subjects. Feces and serum samples were meticulously collected, with stool samples subjected to 16S rRNA sequencing targeting region V4 and untargeted metabolomics analysis, while serum samples underwent untargeted metabolomics assessment.</div></div><div><h3>Results</h3><div>A total of 21 different genus-level species were identified in the SZ and HC groups. Predictive analysis of gut flora pathways revealed abnormal fatty acid degradation in schizophrenia. Notably, 17 differential fatty acid metabolites were found in feces, whereas 43 were found in serum fatty acid metabolites. A higher proportion of differential fatty acid metabolites were found in serum compared to those in feces. The predominant pathways enriched in fatty acid metabolites included biosynthesis of unsaturated fatty acids, arachidonic acid metabolism, and linoleic acid metabolism. Additionally, a significant correlation was noted between intestinal flora and fatty acids, as well as potential interactions between intestinal flora, fecal fatty acids and serum fatty acids.</div></div><div><h3>Conclusions</h3><div>Our multi-omics study provides new insights into the pathogenesis of schizophrenia, which may inform the treatment of neurodevelopmental disorders by modifying fatty acid metabolism through modulation of the gut microbiota.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 94-105"},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The problem of missing data for learning health systems focused on first-episode psychosis","authors":"Delbert G. Robinson ,&nbsp;Nina R. Schooler ,&nbsp;Majnu John ,&nbsp;John Daniel Cahill ,&nbsp;Cristina Gomes Gonzalez ,&nbsp;Patricia Marcy ,&nbsp;Catherine Adams ,&nbsp;Mary Distasio ,&nbsp;Carla Gerber ,&nbsp;Brienne Hackett ,&nbsp;Maria Sanchez Nunez ,&nbsp;Vinod H. Srihari ,&nbsp;John M. Kane","doi":"10.1016/j.schres.2025.03.021","DOIUrl":"10.1016/j.schres.2025.03.021","url":null,"abstract":"<div><h3>Background</h3><div>A Learning Health System (LHS) requires data to improve care.</div></div><div><h3>Design</h3><div>Data are from the ESPRITO LHS that includes 13 US clinics providing coordinated specialty care (CSC) for first-episode psychosis. Causes of missing data examined were: clinic patients not enrolling in ESPRITO, participants prematurely disengaging from treatment and missing patient-reported outcomes.</div></div><div><h3>Results</h3><div>ESPRITO informed consent used a verbal opt-out format. This resulted in a high participant agreement rate (83.5 %) but limitations on data sharing within ESPRITO. During a 6-month period, 15.4 % of ESPRITO participants prematurely terminated treatment. An exploratory analysis revealed factors associated with increased premature termination likelihood: being homeless or having unstable housing, not being prescribed a long-acting injectable antipsychotic and factors associated with decreased premature termination likelihood: having commercial insurance, longer duration of CSC treatment, better scores on the Global Functioning: Social Scale and reporting higher likelihood to attend on the Intent to Attend scale. Examining patient-reported outcomes, rates of missing data with participants still in treatment on the Questionnaire about the Process of Recovery were 26.5 % at first major assessment rising up to 59.8 % on later assessments.</div></div><div><h3>Conclusions</h3><div>Missing data are a substantial problem for first-episode psychosis-focused LHS. LHS designs should consider factors that may influence LHS data participation and a LHS research priority should be developing interventions to decrease missing data. LHS data analyses should also consider potential differential characteristics of individuals who are versus who are not included in LHS data sets.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 79-86"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associations of fatigue in psychosis: A systematic review and meta-analysis","authors":"Kim Poole-Wright ,&nbsp;Aakash Patel ,&nbsp;Fiona Gaughran ,&nbsp;Robin Murray ,&nbsp;Trudie Chalder","doi":"10.1016/j.schres.2025.03.027","DOIUrl":"10.1016/j.schres.2025.03.027","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing interest in fatigue in people with psychotic illnesses. This systematic review and meta-analysis reviewed the evidence concerning the prevalence of fatigue and associated factors in adults with psychotic illnesses.</div></div><div><h3>Methods</h3><div>Embase, PsycINFO, Medline and CINAHL were systematically searched for articles in English published between January 1946 to 9 October 2023. Inclusion criteria was ‘fatigue’ in adults (≥18 years old) with a confirmed ICD11 or DSM5 diagnosis of a psychotic disorder. Risk of bias was assessed with the JBI and the Newcastle-Ottawa Scale. Pooled proportions for fatigue with 95 % CI were calculated using random effects models. Heterogeneity was assessed using Cochran's Q and I² statistic and Egger's tests were conducted for publication bias.</div></div><div><h3>Results</h3><div>A total of 57 articles met the inclusion criteria and 7 articles (<em>n</em> = 1161 participants) were included for the meta-analysis of fatigue. Fatigue prevalence was 55 % (95 % CI: 37–71 %, I² = 94 %). A sensitivity analysis of the 6 studies using a valid scale (<em>n</em> = 711 participants) found a fatigue proportion of 59 % (95 % CI: 41–76, I² = 93 %). Eighteen studies (<em>n</em> = 4569 participants) were included for an analysis exploring the prevalence of antipsychotic-related fatigue, which was 20.5 % (95 % CI: 11–34 %). We found no significant difference in antipsychotic-related fatigue between studies using a valid scale (27 %, 95 % CI: 14–46, k = 7) and studies using a clinical interview (17 %, 95 % CI: 7–35 %, k = 11) <em>p</em> = 0.302. An Egger's test indicated no publication bias. Quality assessments for included studies revealed that 16 % were at low risk of bias, 9 % at high risk and 75 % at moderate risk. Reported associations with fatigue included sex, age, antipsychotics, distress and depression, sleep, and some negative symptoms.</div></div><div><h3>Conclusions</h3><div>Our study revealed that a majority of people with psychosis experience fatigue. Antipsychotics, sex, and functioning may contribute to tiredness symptoms, but further research is needed.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 59-70"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OnTrackNY: A public sector learning healthcare system for youth and young adults with early psychosis","authors":"Iruma Bello ,&nbsp;Ana Stefancic ,&nbsp;Ana Carolina Florence ,&nbsp;Melanie Wall ,&nbsp;Marleen Radigan ,&nbsp;Igor Malinovsky ,&nbsp;Ilana Nossel ,&nbsp;Chackupurackal Mathai ,&nbsp;Leopoldo Cabassa ,&nbsp;Kaleigh Fidaleo ,&nbsp;Adrienne Sheitman ,&nbsp;Elaina Montague ,&nbsp;William McGuire ,&nbsp;Thomas E. Smith ,&nbsp;Lisa Dixon ,&nbsp;Sapana Patel","doi":"10.1016/j.schres.2025.03.033","DOIUrl":"10.1016/j.schres.2025.03.033","url":null,"abstract":"<div><div>Coordinated Specialty Care is a treatment model for youth and young adults experiencing early psychosis. OnTrackNY, an internationally recognized public sector learning healthcare system, operates 31 coordinated specialty care teams throughout New York State with oversight from an intermediary organization, OnTrack Central. As part of the National Institute of Mental Health Early Psychosis Intervention Network initiative, OnTrackNY utilizes a stakeholder engagement unit and a data science unit to support quality improvement. This article describes how OnTrack Central uses the Institute of Medicine's Group Health Cooperative learning healthcare system framework and learning loop approach to enhance racial equity in OnTrackNY through a multi-component quality improvement project. Qualitative interviews (<em>N</em> = 70) with OnTrackNY participants, families, and providers revealed experiences with racism and shared decision making and identified stakeholder-driven modifications to OnTrack Central's training and implementation approach. Modifications included stakeholder co-created shared decision making training modules for providers and ethnoracially minoritized participants, and a provider learning collaborative to promote shared decision making with ethnoracially diverse participants and families. Evaluation of the modules and collaborative identified barriers including limited time for providers to engage with training and a lack of confidence among trainers in delivering racial equity trainings. Results highlighted the need to adjust content and develop two workforce training programs focused on enhancing shared decision making along the continuum of OnTrackNY care. This article demonstrates how a public sector learning healthcare system can use a stakeholder-partnered approach to enhance the competency of coordinated specialty care workforce and promote equitable and data-driven care.</div></div>","PeriodicalId":21417,"journal":{"name":"Schizophrenia Research","volume":"279 ","pages":"Pages 50-58"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}