OBJECTIVE: To evaluate the effectiveness of a service for early psychosis.
DESIGN: Randomised controlled clinical trial.
SETTING: Community mental health teams in one London borough.
PARTICIPANTS: 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis.
INTERVENTIONS: Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams.
PRIMARY OUTCOME MEASURES: Rates of relapse and readmission to hospital.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.
AIMS: 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.
METHOD: 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.
RESULTS: 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.
CONCLUSIONS: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.
Background: Early specialised care may improve short-term outcome in first-episode non-affective psychosis, but it is unclear if these benefits endure. Aims: To assess the long-term effect of early intervention in psychosis. Method: Individuals with first-episode psychosis were randomised to specialised care or care as usual (trial number: ISRCTN73679874). Outcome after 5 years was assessed by case-note review. Results: There were no significant differences in the admission rate (coefficient 0.096, 95% CI -0.550 to 0.742, P = 0.770) or the mean number of bed days (coefficient 6.344, 95% CI -46 to 58.7, P = 0.810). Conclusions: These findings that specialist intervention did not markedly improved outcome at 5 years accord with those from a larger OPUS study. The sample size of this study was small and these results should be generalised with caution. More research is needed.
Background: There is concern that delaying treatment for psychosis may have a negative impact on its long-term course. A number of countries have developed early intervention teams but there is limited evidence regarding their cost-effectiveness. Aims: To compare the costs and cost-effectiveness of an early intervention service in London with standard care. Method: Individuals in their first episode of psychosis (or those who had previously discontinued treatment) were recruited to the study. Clinical variables and costs were measured at baseline and then at 6- and 18-month follow-up. Information on quality of life and vocational outcomes were combined with costs to assess cost-effectiveness. Results: A total of 144 people were randomised. Total mean costs were £11 685 in the early intervention group and £14 062 in the standard care group, with the difference not being significant (95% CI -£8128 to £3326). When costs were combined with improved vocational and quality of life outcomes it was shown that early intervention would have a very high likelihood of being cost-effective. Conclusions: Early intervention did not increase costs and was highly likely to be cost-effective when compared with standard care.
<b>OBJECTIVES: </b>Specialized early intervention by a team providing assertive community treatment (ACT) is beneficial to the recovery, housing, and employment of individuals with schizophrenia, but few studies have examined its effect on social support. This study assessed whether the ACT model of care was related to clinical and social outcomes among patients who had experienced a first episode of psychosis. <b>METHODS: </b>The sample was drawn from the Lambeth Early Onset Trial, a study of 144 patients in the United Kingdom who sought treatment for a first episode of psychosis between January 2000 and October 2001 and who were randomly assigned to a specialized early intervention modeled on ACT or standard care. The Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Significant Others Scale were administered at six-month and 18-month follow-ups. <b>RESULTS: </b>Data on social support were available at both follow-ups for 57 patients assigned to specialized care and 50 patients assigned to standard care. The two groups were similar in personal characteristics, relationship status, and living arrangements at baseline and at six-month follow-up, but by 18 months, patients in specialized care reported having a higher mean±SD number of significant others in their social networks than did standard care patients (2.40±1.20 and 1.71±1.06, respectively; p=.01). They also achieved superior clinical outcomes at 18 months, and these outcomes were associated with network size. <b>CONCLUSION: </b>Early intervention by using an ACT model of care may improve clinical results by reestablishing or maintaining bonds between patients and family, friends, and acquaintances.
To evaluate the effectiveness of a service for early psychosis.
DESIGN:
Randomised controlled clinical trial.
SETTING:
Community mental health teams in one London borough.
PARTICIPANTS:
144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis.
INTERVENTIONS:
Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams.
PRIMARY OUTCOME MEASURES:
Rates of relapse and readmission to hospital.
RESULTS:
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.
CONCLUSIONS:
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.
