Monday, August 2, 2021

Early Psychosis Intervention Can Be as Effective in Real World as in Clinical Trial Environment

An intervention for patients with first-episode psychosis known as OPUS is as effective—and in some cases superior—in real-world clinical practice as was found when the intervention was tested in clinical trials, according to a report in AJP in Advance.

“Early intervention services for psychosis are, by definition, a complex psychosocial intervention, and, once implemented, they may not be delivered with the same rigorous attention to program fidelity, low caseload, motivation, and so on as they had in the controlled environment of a randomized trial,” wrote Christine Merrild Posselt, M.Sc., of Copenhagen University Hospital and colleagues. “The study results provide further evidence in support of implementation and funding of early intervention services worldwide.”

OPUS is a modified form of assertive community treatment for psychosis that includes family involvement and social-skills training provided by a multidisciplinary team of psychiatrists, psychologists, nurses, social workers, physiotherapists, and vocational therapists. A clinical trial of 547 adults showed OPUS was superior to standard care, which led to broad implementation of this program in Denmark in 2003.

For the current study, Posselt and colleagues compared the five-year outcomes of 3,328 patients who received OPUS after this implementation—identified using Danish health registers—with the five-year outcomes of 545 of the original clinical trial participants. This period included two years of OPUS intervention and three years of follow-up.

The researchers found that patients receiving OPUS had lower odds of a psychiatric hospital admission than the clinical trial participants across the five-year time span, as well as lower rates of psychotropic medication use. Rates of suicide or death by any cause were similar for patients receiving OPUS as well as the clinical trial participants. OPUS patients were less likely to work or attend school than their clinical trial counterparts during the first three years after initiating OPUS, but by year five, had higher odds of being in work or school.

“Positive effects beyond those observed in the randomized trial may be due to more flexible setups, improved experience with delivering the intervention, or other factors,” Posselt and colleagues wrote. “We accounted for potential differences in patient characteristics in the analyses, which suggests that this is not likely to have been a confounder in our results.”

To read more on this topic, see the Psychiatric Services article “Implementing Evidence-Based Interventions to Improve Vocational Recovery in Early Psychosis: A Quality-Improvement Report.”



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