Specialised care for early psychosis: Symptoms, social functioning and patient satisfaction - Randomised controlled trial

The University of Manchester, Manchester, England, United Kingdom
The British Journal of Psychiatry (Impact Factor: 7.99). 02/2006; 188(1):37-45. DOI: 10.1192/bjp.bp.104.007286
Source: PubMed


The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.
To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction.
One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately.
Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups.
The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

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    • "Research findings support a number of key elements of early intervention programs, yet there is variability in their implementation (Catts et al., 2010; Ghio et al., 2012; McGorry et al., 2008; Srihari et al., 2012). Some programs stress the importance of case management, while others focus on medication or social and functional recovery (Garety et al., 2006; Spencer et al., 2001). Although variation exists, most studies indicate key components such as: pharmacological interventions , cognitive-behavioral treatment, family interventions, and vocational services (Allott et al., 2011; De Masi et al., 2008; Hill et al., 2012; Spencer et al., 2001). "
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    ABSTRACT: Programs providing interventions for early psychosis are becoming commonplace in the United States (U.S.); however, the characteristics of existing services remain undocumented. We examined program characteristics, clinical services, and program eligibility criteria for outpatient early intervention programs across the U.S. using a semi-structured telephone interview. Content analysis was used to identify the presence or absence of program components, based in part on a recent list of essential evidence-based components recommended for early intervention programs (Addington, MacKenzie, Norman, Wang and Bond, 2013) as well as program characteristics, including eligibility criteria. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the examined components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The populations served by US programs were most frequently defined by restrictions on the duration of psychosis and age. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for future improvement. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Aug 2015 · Schizophrenia Research
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    • "Sparking optimism among clinicians, researchers, patients and their families, EI services have generated significant interest, particularly in the last 15 to 20 years. At least three randomized controlled studies (Bertelsen et al., 2008; Craig et al., 2004; Garety et al., 2006) and one meta-analysis (Harvey et al., 2007) have shown that specialized EI services yield better outcomes than standard care. Along with a few other countries, Canada has been at the forefront of EI service development and research (Iyer et al., 2015; Iyer and Malla, 2014). "
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    ABSTRACT: This paper provides an overview of early intervention (EI) services for psychosis in Canada. We describe a leading Canadian EI program's approach to enhancing access (via early case detection, open referral, and rapid response) and providing specialized phase-specific treatment. Learnings from this program's research/evaluation indicate that EI can significantly improve service user and family engagement. Achieving and maintaining symptom remission (particularly negative symptoms) may be important for better social and occupational functioning in first-episode psychosis (FEP). Our program demonstrates the feasibility of establishing and sustaining an open referral, rapid-response system to address the chronic systemic problems of long waiting lists and barriers to access. We argue that an integrated clinical-research program based on specialized EI guidelines can significantly improve outcomes and advance FEP research.
    Full-text · Article · Apr 2015 · The Journal of nervous and mental disease
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    • "The outcomes were also better in satisfaction (Verona Service Satisfaction Scale), quality of life (MANSA), and pharmacological adherence. In addition, the patients maintained educational or work activities for a longer period of time than the control group (6.9 vs. 4.2 months) (11). Patients receiving specialized care reported a greater average number of significant others in their social network (2.40 ± 1.20 vs. 1.71 ± 1.06), which linear regression analysis correlated with significant improvement in total PANNS and GAF (β = 2.95, SE = 1.04), showing the importance of social network in clinical improvement (12). "
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    ABSTRACT: Background: In Chile, the clinical guidelines “For the Treatment of People from First Episode of Schizophrenia” aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. Objectives: This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. Methodology: An electronic search was carried out using PUBMED, LILACS and Science-Direct as databases. Criteria of inclusion: i: randomized clinical trials, ii. Community-based interventions, iii. diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). Exclusion Criteria: i. treatments exclusively pharmacological, ii. Interventions carried out in inpatient settings, ii. bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). Results: 66 articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. Conclusions: Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
    Full-text · Article · Oct 2013 · Frontiers in Psychiatry
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