Wednesday, May 2, 2018

With Early Intervention, Patients With Schizophrenia Experience Greater Improvements in Health, Function

Patients with early-phase psychosis who received integrated, coordinated antipsychotic treatment and psychosocial care experienced greater improvements in health and function over a two-year period than those who did not participate in these programs, according to a comprehensive meta-analysis published today in JAMA Psychiatry. Such outcomes included a reduced risk of hospitalization and treatment discontinuation, shorter stays at the hospital, and better quality of life.

“These findings should provide further impetus for the widespread implementation and funding of EIS [early intervention services] in the United States and across the world, as has already begun,” wrote Christoph Correll, M.D., of the Zucker Hillside Hospital in Glen Oaks, N.Y., and colleagues.

Correll and colleagues searched the literature for randomized, controlled trials comparing outcomes in patients who received early intervention services (including several psychosocial and psychopharmacological interventions) with those who received nonspecialized treatment as usual. This search yielded 10 such studies, including 2,176 patients (mean age 27.5 years), followed for 9 to 24 months.

The meta-analysis revealed that EIS was associated with better outcomes than treatment as usual at the end of treatment for all the outcomes examined, including all-cause treatment discontinuation, at least one psychiatric hospitalization, involvement in school or work, total symptom severity, positive symptom severity, and negative symptom severity. Correll and colleagues noted that the superiority of EIS was evident at 6, 9 to 12, and 18 to 24 months of treatment, except for general symptom severity and depressive symptom severity at 18 to 24 months in several studies included in the analysis.

“Given that schizophrenia is one of the disorders most associated with personal distress and societal cost, sustaining gains achieved by EIS could be cost-effective,” they wrote. “Therefore, additional trials are needed that study different EIS extension vs. step-down procedures for patient subgroups that can move between these options based on identified needs.”

For related information, see the Psychiatric News article “Youth Later Diagnosed With Psychotic Disorders May Show Up in Acute Care Settings First” and the Psychiatric Services article “Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program.”

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