Article

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

The University of Manchester, Manchester, England, United Kingdom
BMJ (online) (Impact Factor: 17.45). 12/2004; 329(7474):1067. DOI: 10.1136/bmj.38246.594873.7C
Source: PubMed

ABSTRACT

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.

Download full-text

Full-text

Available from: Miriam Fornells-Ambrojo
  • Source
    • "Multi-element intervention studies in FEP were excluded as the current review aims at understanding the evidence of a single intervention (family intervention). To clarify, family interventions were given in many early intervention trials along with patient-oriented pharmacological and non-pharmacological interventions such as social skill training, cognitive–behavioral therapy (CBT) and crisis intervention (Bertelsen et al., 2008; Craig et al., 2004; Grawe, Falloon, Widen, & Skogvoll, 2006; Jeppesen et al., 2005; Kuipers, Holloway, Rabe-Hesketh, & Tennakoon, 2004; Petersen et al., 2005; Tempier, Balbuena, Garety, & Craig, 2012). Such study reports were not included because it was difficult to isolate the efficacy of any single intervention (family intervention) effectiveness. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Family interventions have produced benefits on clinical and family outcomes in long standing psychosis. However, little is known about the efficacy of such interventions in the early stages of psychosis. This article reviews published research over the last two decades on family intervention in first-episode psychosis. Electronic databases, such as PubMed, PsycINFO, and ScienceDirect, have been systematically searched. In addition, an exhaustive Internet search was also carried out using Google and Google Scholar to identify the potential studies that evaluated family interventions in first-episode psychosis. We have identified seven reports of five randomized controlled trials (RCTs) and five non-randomized and uncontrolled studies of family intervention. Our review on 12 reports of family intervention studies has shown mixed effects on outcomes in first-episode psychosis. Most of the reports showed no added benefits or very short-term benefits on primary clinical or family outcome variables. There is a dearth of family intervention studies in first-episode psychosis. More RCTs are needed to reach reliable conclusions.
    Full-text · Article · Nov 2015 · SAGE Open
  • Source
    • "EI services consider psychotic experiences to be dynamic and reversible in their nature and focus upon recovery rather than management (Johannessen, 2004). EI services have been shown to have effective clinical, social and vocational outcomes (Bird et al., 2010; Craig et al., 2004), though little is known about long-term benefits (Bird et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: A biopsychosocial model of care (integrating biological and psychosocial supoprt) is often applied within Early Intervention for Psychosis services. The current study aims to explore the experience of people engaging with a process of psychosocial formulation whilst also being supported by clinicians representing a biological understanding of psychosis. Design: A qualitative design is used, with data collected through semi-structured interviews. Methods: 9 individuals from Early Intervention services were interviewed regarding their experience of engaging in psychosocial formulation whilst concurrently receiving ongoing support from a medical perspective. Results: 3 common themes were identified across the experience of the participants. These were (i) a joined-up ‘package’ of support (ii) formulation makes a distinctive contribution to the ‘package’ (iii) shaping the experience. Conclusions: The biopsychosocial model of care for first episode psychosis was experienced by participants as offering a sense of a coherent support ‘package’. This was multi-faceted, of which psychosocial formulation was identified as making a distinctive contribution. Participants also exerted agency upon their experience of the biopsychosocial model of care and were able to shape their support in a way that was most personally meaningful. Suggestion of the existence of a continuum of experience of psychosocial formulation within this context is discussed, in addition to implications for clinical practice regarding the need to enhance the malleable nature of the biopsychosocial model.
    Full-text · Article · Oct 2015 · International Journal of Psychosocial Rehabilitation
  • Source
    • "Adaptations of ACT have been tested for several specialist teams. Early Intervention Services for psychosis have been trialled (Craig et al. 2004; Petersen et al. 2005) as have crisis intervention teams (Johnson et al. 2005) with broadly similar conclusions. Careful comparisons between these studies, and in particular their outcomes, has led to a sharper understanding of the processes needed to support severely mentally ill patients in the community. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mental health care in the second half of the 20th century in much of the developed world has been dominated by the move out from large asylums. Both in response to this move and to make it possible, a pattern of care has evolved which is most commonly referred to as 'Community Psychiatry'. This narrative review describes this process, from local experimentation into the current era of evidence-based mental health care. It focuses on three main areas of this development: (i) the reprovision of care for those discharged during deinstitutionalisation; (ii) the evolution and evaluation of its characteristic feature the Community Mental Health Team; and (iii) the increasing sophistication of psychosocial interventions developed to support patients. It finishes with an overview of some current challenges.
    Full-text · Article · Sep 2014 · Epidemiology and Psychiatric Sciences
Show more