Specialized early intervention programs for psychosis show long-term benefits
MedWire News: Specialized early intervention programs for patients with a first episode of psychosis appear to have a long-term beneficial effect in terms of symptomatic remission and social/vocational outcomes, findings from the prospective follow-up EPPIC study show.
"The historical 'clinician's illusion'... of poor overall outcome for individuals with psychotic disorders may no longer be applicable with the introduction of early intervention services," say Lisa Henry, from ORYGEN Research Centre in Melbourne, Australia, and colleagues.
For the naturalistic EPPIC (Early Psychosis Prevention and Intervention Centre) study, an epidemiologic sample of 723 first-episode psychosis patients who received specialized intervention for at least the first 2 years of their illness were followed-up between January 1998 and April 2005. This was a median of 7.4 years after the patients initially presented to the center.
Follow-up information was collected for 651 (90%) of the original sample, including 374 with schizophrenia, 61 with schizoaffective disorder, 161 with affective psychosis, and 55 with other psychoses. The mean age of the participants was 28.7 years.
Of 424 individuals for whom rating on all symptoms required to determine remission status were available, 250 (59%) met the Brief Psychiatric Rating Scale (BPRS) criteria of scoring no greater than 3 (mild) concurrently on the items: grandiosity, suspiciousness, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerisms/posturing, and blunted affect.
When this BPRS criteria plus the Schedule for the Assessment of Negative Symptoms (SANS) criteria of a score of 2 or less for affective flattening, avolition-apathy, anhedonia-asociality, and alogia, were combined, 156 (36.8%) patients were classified as being in symptomatic remission.
Patients with affective psychosis were more likely to achieve symptomatic remission than the other patients.
Social/vocational recovery was observed in 31% (147/482) of the patients, based on scoring at least 4 on the Quality of Life Scale (QLS) for social activity, occupational role functioning, and being able to carry out commonplace activities.
The percentage of patients who achieved both symptomatic remission and social/vocational recovery ranged from 23.5 to 25.6%, depending on whether BPRS criteria alone, or BPRS plus SANS criteria were used.
Henry et al conclude in the Journal of Clinical Psychiatry that their results are "consistent with a beneficial effect of specialized early intervention programs." But they note that their methodology was unable to definitively examine this issue.
They call for further study, and point out that "extending specialized early psychosis treatment beyond the first 2 years and providing specialized vocational programs may be crucial to build on the initial superior improvement in clinical and functional outcomes delivered by specialized care for individuals experiencing first-episode psychosis."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Lucy Piper