Early Intervention in the Early Phase of Psychosis
A meta-analysis of 10 randomized studies examined whether early intervention in the initial phase of psychosis in patients with schizophrenia is associated with better outcomes than usual care.
Introduction
Several research programs for patients with early-phase schizophrenia spectrum disorder have shown promising results for early intervention services (EIS). This approach requires a multidisciplinary team of mental health specialists who provide various psychosocial and psychopharmacological interventions according to the individual's needs. Within EIS, care is provided by one team led by a coordinator instead of referring the patient to various healthcare providers for individual interventions. The goal is to reduce psychosis symptoms, improve functional outcomes, and shorten long-term disability during the critical phase of the disease.
Analyzed Data
The authors conducted a systematic literature search in the PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov databases published up to June 6, 2017, without language restrictions. They searched for randomized studies comparing EIS and usual care. The study had two co-primary endpoints: discontinuation of treatment for any reason and at least one psychiatric hospitalization during the treatment period. Eleven other parameters were also evaluated.
The included studies comprised a total of 2176 patients with an average age of 27.5 years, of whom 62.3% were male. The average study duration was 16.2 months (range 9–24 months). The average baseline score on the Brief Psychiatric Rating Scale (BPRS) converted to the Positive and Negative Syndrome Scale (PANSS) was 72.8, the average duration of illness (from the first symptoms to study entry) was 159.8 weeks, and the average duration of untreated psychosis (from the first psychosis symptoms to the first antipsychotic) was 79.9 weeks.
Findings
EIS showed better results than usual care regarding both co-primary endpoints and all other evaluated variables. Patients with EIS discontinued treatment significantly less often than those with usual care (21.3% vs. 31.3%; relative risk [RR] 0.70; 95% confidence interval [CI] 0.61–0.80; p < 0.001) and significantly fewer patients with EIS underwent at least one psychiatric hospitalization (32.3% vs. 42.4%; RR 0.74; 95% CI 0.61–0.90; p = 0.003).
Other evaluated variables where EIS achieved better results compared to usual care include the proportion of patients attending school/work, overall symptom severity, severity of positive symptoms, severity of negative symptoms, severity of general symptoms, severity of depressive symptoms, overall functioning, relapse proportion, remission and recovery rates, and quality of life. The benefits of EIS over usual care were observed at 6, 9–12, and 18–24 months of treatment (except for the severity of general symptoms and depressive symptoms at 18–24 months).
Conclusion
Early intervention led to significantly better outcomes for all evaluated parameters in patients with early-phase schizophrenia than usual care. These results support the use of EIS in the early stages of schizophrenia development.
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Source: Correll CU, Galling B, Pawar A. et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry 2018; 75 (6): 555–565, doi: 10.1001/jamapsychiatry.2018.0623.
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