No quality of life benefits with intensive first-episode psychosis treatment
MedWire News: An intensive integrated treatment for first-episode psychosis (FEP) does not improve quality of life over standard treatment, despite improving clinical outcome and treatment adherence, conclude Danish investigators.
The OPUS trial compared standard treatment with a 2-year intensive integrated treatment for FEP consisting of assertive community treatment with programs for family involvement and social skills training. Intensive treatment comparatively reduced psychotic and negative symptoms, as well as improved patient satisfaction, treatment adherence, and reduced substance misuse.
To determine the impact of the intensive treatment on quality of life, from both an objective and subjective standpoint, Anne Thorup and colleagues from Bispebjerg Hospital in Copenhagen studied baseline and 2-year Lancashire Quality of Life Profile (LQoLP) scores for the 280 patients in the OPUS trial.
For both standard treatment and intensive treatment patients, average scores on all nine domains of the LQoLP increased between baseline and follow-up, with no significant differences between the groups.
Further analysis showed that, of the 147 patients who completed the question “What could improve your quality of life in your opinion?” at 2 years, 81 sought to improve their social network or family relations, with 39 of these wishing to meet a new partner. In addition, 16 patients desired improvements in their self-esteem.
Even while including intensive treatment as a fixed factor, backwards-stepwise multivariate regression analysis indicated that the only factors that predicted perceived quality of life were “negative dimension” and “self-esteem.”
“The integrated psychosocial treatment provided by the ‘OPUS’ team did not improve the patient's subjective quality of life significantly more than the standard treatment,” the team writes in the journal Schizophrenia Research.
“Quality of life in this population of young adults with a first-episode psychosis was rather low and correlated with psychopathology affective balance and self-esteem. When asked directly, many answers indicate that self-esteem and social network are important parameters for the patients in this context.”
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By Liam Davenport