Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.
IMPORTANCE: The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal.
OBJECTIVE: To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis.
DATA SOURCES: Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017.
STUDY SELECTION: Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders.
DATA EXTRACTION AND SYNTHESIS: This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses.
MAIN OUTCOMES AND MEASURES: The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period.
RESULTS: Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months).
CONCLUSIONS AND RELEVANCE: In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
Antecedentes: En Chile, las guías clínicas "para el tratamiento de las personas de primer episodio de esquizofrenia" tienen como objetivo apoyar a las personas con esquizofrenia a vivir de forma independiente, de establecimiento de metas profesionales, y tener una adecuada calidad de vida y la interacción social. Esto requiere la implementación de un modelo de tratamiento que integre las dimensiones psicosociales y farmacológicos. Estrategias de intervención comunitaria de garantizar la consecución de estos objetivos. Objetivos: Este estudio recopila y sintetiza la evidencia científica disponible de los últimos 14 años sobre la eficacia de las estrategias de intervención comunitaria para la esquizofrenia y los trastornos psicóticos relacionados. Metodología: En una búsqueda electrónica se realizó mediante PUBMED, LILACS y Science Direct como bases de datos. Criterios de inclusión: (i) los ensayos clínicos aleatorios, (ii) las intervenciones basadas en la comunidad, (iii) el diagnóstico de esquizofrenia o trastorno psicótico relacionados (sección F2 de la CIE-10). Criterios de exclusión: (i) los tratamientos exclusivamente farmacológica, (ii) las intervenciones realizadas en pacientes hospitalizados, (iii) el trastorno afectivo bipolar o psicosis inducida por sustancias (mayor que 50% de la muestra). Resultados: Sesenta y seis artículos fueron revisados. Estrategias comunitarias para el tratamiento integrado del primer brote de esquizofrenia redujeron significativamente los síntomas negativos y psicóticos, días de hospitalización, y la comorbilidad con abuso de sustancias y la mejora del funcionamiento global y la adherencia al tratamiento. En otras etapas, hubo mejora de los resultados en los síntomas positivos y negativos y psicopatología general. Psicoeducación para pacientes y familias reduce los niveles de auto-estigma y la violencia doméstica, así como un mejor conocimiento de la enfermedad y la adherencia al tratamiento. Formación centrada en habilidades cognitivas, sociales, y laborales se ha demostrado que mejora el rendimiento en el funcionamiento social y la situación laboral. Conclusión: las estrategias de intervención basadas en la comunidad tienen un amplio apoyo en el tratamiento de pacientes con esquizofrenia.
Despite convincing evidence of short-term symptom control and functional recovery of patients with psychosis after receiving early intervention (EI) services, little is known about the long-term outcomes of EI for these patients. This review aims to evaluate the effectiveness of EI services in improving long-term outcomes of patients with psychosis. A systematic literature search was conducted on PubMed, PsycINFO, Scopus, Medline, CINAHL, BIOSIS, and EMBASE electronic databases to identify studies that evaluated long-term outcomes of patients with psychosis measured 5 years or beyond after entering the EI service. Of 13,005 articles returned from the search, 14 eligible articles reporting study cohorts from nine EI services in seven countries and regions were identified. Data on study design, patient characteristics, intervention components, and outcomes were extracted and reviewed. Only a few studies reported better longitudinal outcomes for negative symptoms, mortality, employment, and hospitalization in patients received EI services. However, results from cross-sectional measurements provided little evidence for long-term impacts of EI services on clinical and functional outcomes. A dilution effect of benefits over time was also demonstrated in several studies. This review highlights the gap in current EI service provision and suggests possible future directions for service improvement and further research.
