Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis

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Abstract

The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal.

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A systematic review and meta-analysis of recovery in schizophrenia.

E. Jääskeläinen, P Juola, N Hirvonen … (2013)

Our primary aims were (a) to identify the proportion of individuals with schizophrenia and related psychoses who met recovery criteria based on both clinical and social domains and (b) to examine if recovery was associated with factors such as gender, economic index of sites, and selected design features of the study. We also examined if the proportions who met our definition of recovery had changed over time. A comprehensive search strategy was used to identify potential studies, and data were extracted for those that met inclusion criteria. The proportion who met our recovery criteria (improvements in both clinical and social domains and evidence that improvements in at least 1 of these 2 domains had persisted for at least 2 years) was extracted from each study. Meta-regression techniques were used to explore the association between the recovery proportions and the selected variables. We identified 50 studies with data suitable for inclusion. The median proportion (25%-75% quantiles) who met our recovery criteria was 13.5% (8.1%-20.0%). Studies from sites in countries with poorer economic status had higher recovery proportions. However, there were no statistically significant differences when the estimates were stratified according to sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up, or other design features. Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased.

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Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden

Merete Nordentoft, Kristian Wahlbeck, Jonas Hällgren … (2013)

Background Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. Objective To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. Methods In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. Results The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. Conclusions These alarming figures call for action in order to prevent the high mortality.

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The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis.

Mohamed N. Rahaman, Graham Dunn, Philippa Garety … (2004)

To evaluate the effectiveness of a service for early psychosis. Randomised controlled clinical trial. Community mental health teams in one London borough. 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis. Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams. Rates of relapse and readmission to hospital. Compared with patients in the standard care group, those in the specialised care group were less likely to relapse (odds ratio 0.46, 95% confidence interval 0.22 to 0.97), were readmitted fewer times (beta 0.39, 0.10 to 0.68), and were less likely to drop out of the study (odds ratio 0.35, 0.15 to 0.81). When rates were adjusted for sex, previous psychotic episode, and ethnicity, the difference in relapse was no longer significant (odds ratio 0.55, 0.24 to 1.26); only total number of readmissions (beta 0.36, 0.04 to 0.66) and dropout rates (beta 0.28, 0.12 to 0.73) remained significant. Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to standard care for maintaining contact with professionals and for reducing readmissions to hospital. No firm conclusions can, however, be drawn owing to the modest sample size.

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Author and article information

Journal

Title: JAMA Psychiatry

Abbreviated Title: JAMA Psychiatry

Publisher: American Medical Association (AMA)

ISSN (Print): 2168-622X

Publication date Created: June 01 2018

Publication date (Print): June 01 2018

Volume: 75

Issue: 6

Page: 555

Affiliations

[1 ]Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York

[2 ]Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York

[3 ]The Feinstein Institute for Medical Research, Manhasset, New York

[4 ]Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany

[5 ]Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy

[6 ]Institute of Psychiatry, King’s College London, London, England

[7 ]Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

[8 ]The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark

[9 ]Department of Psychiatry, Yale University, New Haven, Connecticut

[10 ]Specialized Treatment Early in Psychosis (STEP) Program, Connecticut Mental Health Center, New Haven

[11 ]Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands

[12 ]Department of Psychiatry, University of Hong Kong, Hong Kong, China

[13 ]State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China

[14 ]Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico

[15 ]Department of Psychiatry, SUNY Downstate Medical Center, New York, New York

[16 ]Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire

[17 ]Bureau of Behavioral Health, College of Health and Human Services (CHHS), Dartmouth, New Hampshire

[18 ]Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts

[19 ]Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts

[20 ]Department of Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts

[21 ]Department of Epidemiology, Yale University, New Haven, Connecticut

[22 ]Department of Public Health, Yale University, New Haven, Connecticut

[23 ]The Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada

[24 ]Department of Social Medicine, The University of North Carolina at Chapel Hill

[25 ]Nathan Kline Institute, Orangeburg, New York

[26 ]Department of Psychology, The University of North Carolina at Chapel Hill

[27 ]National Institute of Mental Health (NIMH), Bethesda, Maryland

Article

DOI: 10.1001/jamapsychiatry.2018.0623

PMC ID: 6137532

PubMed ID: 29800949

SO-VID: 0bd853b6-3f07-4d3d-ade2-8509944dfde2

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Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis : A Systematic Review, Meta-analysis, and Meta-regression

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Most cited references 22

A systematic review and meta-analysis of recovery in schizophrenia.

Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden

The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis.

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