Five-Year Follow-up of a Randomized Multicenter Trial of Intensive Early Intervention vs Standard Treatment for Patients With a First Episode of Psychotic Illness

BackgroundThe effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.ResultsIt was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.ConclusionsThe study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

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Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study)

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.112300 ◽

2013 ◽

Vol 202 (1) ◽

pp. 35-41 ◽

Cited By ~ 74

Author(s):

Lene Halling Hastrup ◽

Christian Kronborg ◽

Mette Bertelsen ◽

Pia Jeppesen ◽

Per Jorgensen ◽

...

Keyword(s):

Early Intervention ◽

Cost Effectiveness ◽

Standard Treatment ◽

Controlled Trial ◽

Cost Effective ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

The Mean ◽

Randomised Controlled

BackgroundInformation about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.AimsTo evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.MethodAn incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.ResultsThe mean total costs of OPUS over 5 years (€123683, s.e. = 8970) were not significantly different from that of standard treatment (€148751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50000 the probability that OPUS was cost-effective was more than 80%.ConclusionsThe incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.

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Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service

Psychological Medicine ◽

10.1017/s0033291707002656 ◽

2008 ◽

Vol 38 (11) ◽

pp. 1585-1593 ◽

Cited By ~ 45

Author(s):

A. Malla ◽

R. Norman ◽

L. Bechard-Evans ◽

N. Schmitz ◽

R. Manchanda ◽

...

Keyword(s):

Risk Factors ◽

Substance Abuse ◽

Early Intervention ◽

First Episode Psychosis ◽

First Episode ◽

Positive Symptoms ◽

Adherence To Medication ◽

Episode Psychosis ◽

Time To Relapse

BackgroundDifferential association of risk factors associated with relapse following treatment of first-episode psychosis (FEP) have not been studied adequately, especially for patients treated in specialized early intervention (SEI) services, where some of the usual risk factors may be ameliorated.MethodConsecutive FEP patients treated in an SEI service over a 4-year period were evaluated for relapse during a 2-year follow-up. Relapse was based on ratings on the Scale for Assessment of Positive Symptoms (SAPS) and weekly ratings based on the Life Chart Schedule (LCS). Predictor variables included gender, duration of untreated psychosis (DUP), total duration of untreated illness (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse during follow-up and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with the Cox proportional-hazards regression model for time to relapse as the dependent variables.ResultsOf the 189 eligible patients, 145 achieved remission of positive symptoms. A high rate of medication adherence (85%) and relatively low relapse rates (29.7%) were observed over the 2-year follow-up. A higher relapse rate was associated with a co-morbid diagnosis of substance abuse assessed during the follow-up period [odds ratio (OR) 2.84, 95% confidence interval (CI) 1.24–6.51]. The length of time to relapse was not associated with any single predictor.ConclusionsSpecialized treatment of substance abuse may be necessary to further reduce risk of relapse even after improving adherence to medication.

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