Integrated treatment vs. treatment-as-usual for recent onset schizophrenia; 12 year follow-up on a randomized controlled trial

Víðir Sigrúnarson, Rolf W Gråwe, Gunnar Morken, Víðir Sigrúnarson, Rolf W Gråwe, Gunnar Morken

Abstract

Background: The aim of this study is to compare the 12-year follow-up effects on in- and outpatient services of 2 years of integrated treatment for recent-onset schizophrenia versus treatment as usual in a randomized controlled trial.

Methods: 50 patients aged 18-35 years were randomized to Integrated Treatment (IT) (N = 30) or Treatment-as-Usual (TAU) (N = 20) for two years. TAU comprised optimal pharmacotherapy and outreach assertive treatment, while IT also included cognitive-behavioural family treatment, skills training, strategies for residual psychotic and non-psychotic problems and home-based crisis management.

Results: There were no differences in number of days in hospital, time to readmission, number of admittances to psychiatric wards, number of involuntarily psychiatric admissions or number of outpatient contacts over a period of 12 years following the initial 2-year treatment trial. Fewer patients in the IT group were, however, involuntary admitted to hospital in the period.

Conclusions: The intensive two-year psychosocial intervention seemed to have little long-term effects on use of in- and outpatient services.

Trial registration: Current Controlled Trials: NCT00184509.

Figures

Figure 1
Figure 1
Participant flow.
Figure 2
Figure 2
Survival curves for time to readmission after termination of 2 years of treatment trial. IT: Integrated treatment, TAU: treatment as usual. Log rank: P = 0.152.

References

    1. McGorry PD, Killackey E, Yung A. Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry. 2008;7:148–156.
    1. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry. 2010;197:350–356. doi: 10.1192/bjp.bp.109.074526.
    1. Birchwood M, Fiorillo A. The critical period for early intervention. Psychiatr Rehabil Skills. 2000;4:182–198. doi: 10.1080/10973430008408405.
    1. McGorry P, Johanessen JO, Lewis S, Birchwood M, Malla A, Nordentoft M, Addington J, Yung A. Early intervention in psychosis: keeping faith with evidence-based health care. Psychol Med. 2010;40:399–404. doi: 10.1017/S0033291709991346.
    1. Singh SP. Early intervention in psychosis. Br J Psychiatry. 2010;196:343–345. doi: 10.1192/bjp.bp.109.075804.
    1. Grawe RW, Falloon IRH, Widen JH, Skogvoll E. Two years of continued early treatment for recent-onset schizophrenia: a randomised controlled study. Acta Psychiatr Scand. 2006;114:328–336. doi: 10.1111/j.1600-0447.2006.00799.x.
    1. Petersen L, Nordentoft M, Jeppesen P, Øhlenschlæger J, Thorup A, Christensen TØ, Krarup G, Dahlstrøm J, Haastrup B, Jørgensen P. Improving 1-year outcome in first-episode psychosis. Br J Psychiatry. 2005;187:98–103. doi: 10.1192/bjp.187.48.s98.
    1. Álvarez-Jiménez M, Parker AG, Hetrick SE, McGorry PD, Gleeson JF. Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophr Bull. 2011;37:619–630. doi: 10.1093/schbul/sbp129.
    1. McCrone P, Craig TKJ, Power P, Garety PA. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry. 2010;196:377–382. doi: 10.1192/bjp.bp.109.065896.
    1. Gafoor R, Nitsch D, McCrone P, Craig TKJ, Garety PA, Power P, McGuire P. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry. 2010;196:372–376. doi: 10.1192/bjp.bp.109.066050.
    1. Bertelsen M, Jeppesen P, Petersen L, Thorup A, Ohlenschlaeger J, le Quach P, Christensen TO, Krarup G, Jorgensen P, Nordentoft M. 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: the OPUS trial. Arch Gen Psychiatry. 2008;65:762–771. doi: 10.1001/archpsyc.65.7.762.
    1. Nordentoft M, Øhlenschlæger J, Thorup A, Petersen L, Jeppesen P, Bertelsen M. Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders. Psychol Med. 2010;40:1619–1626. doi: 10.1017/S0033291709992182.
    1. Falloon IR. Rehab rounds: optimal treatment for psychosis in an international multisite demonstration project. Psychiatric Services. 1999;50:615–618.
    1. Association AP. Diagnostic and statistical manual of mental disorders DSM-IV. 4 : Amer Psychiatric Pub Inc; 1994.
    1. Morken G, Grawe RW, Widen JH. Effects of integrated treatment on antipsychotic medication adherence in a randomized trial in recent-onset schizophrenia. J Clin Psychiatry. 2007;68:566–571. doi: 10.4088/JCP.v68n0409.
    1. Morken G, Widen J, Grawe R. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry. 2008;8:32. doi: 10.1186/1471-244X-8-32.
    1. Falloon IHR, Fadden G. Integrated mental health care. Cambridge: Cambridge University Press; 1993.
    1. Falloon IRH, collaborators OTP. Integrated mental health care - a guidebook for consumers. Perugia: Optimal Treatment Project, ARIETE; 2001.
    1. Friis S. Early specialised treatment for first-episode psychosis: does it make a difference? Br J Psychiatry. 2010;196:339–340. doi: 10.1192/bjp.bp.109.075143.
    1. Melle I, Larsen TK, Haahr U, Friis S, Johannessen JO, Opjordsmoen S, Simonsen E, Rund BR, Vaglum P, McGlashan T. Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Arch Gen Psychiatry. 2004;61:143–150. doi: 10.1001/archpsyc.61.2.143.
    1. Hegelstad WV, Larsen TK, Auestad B, Evensen J, Haahr U, Joa I, Johannesen JO, Langeveld J, Melle I, Opjordsmoen S. et al.Long-term follow-Up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry. 2012;169:374–380. doi: 10.1176/appi.ajp.2011.11030459.
    1. Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, Barale F, Caverzasi E, McGuire P. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry. 2012;69:220–229. doi: 10.1001/archgenpsychiatry.2011.1472.
    1. Norman RMG, Manchanda R, Malla AK, Windell D, Harricharan R, Northcott S. Symptom and functional outcomes for a 5 year early intervention program for psychoses. Schizophr Res. 2011;129:111–115. doi: 10.1016/j.schres.2011.04.006.
    1. Sanguineti VR, Samuel SE, Schwartz SL, Robeson MR. Retrospective study of 2,200 involuntary psychiatric admissions and readmissions. Am J Psychiatry. 1996;153:392–396.
    1. McEvoy JP, Applebaum PS, Apperson LJ, Geller JL, Freter S. Why must some schizophrenic patients be involuntarily committed? The role of insight. Compr Psychiatry. 1989;30:13–17. doi: 10.1016/0010-440X(89)90113-2.
    1. Kelly BD, Clarke M, Browne S, McTigue O, Kamali M, Gervin M, Kinsella A, Lane A, Larkin C, O’Callaghan E. Clinical predictors of admission status in first episode schizophrenia. European Psychiatry. 2004;19:67–71. doi: 10.1016/j.eurpsy.2003.07.009.
    1. Hustoft K, Larsen TK, Auestad B, Joa I, Johannessen JO, Ruud T. Predictors of involuntary hospitalizations to acute psychiatry. Int J Law Psychiat. 2013;36:136–143. doi: 10.1016/j.ijlp.2013.01.006.
    1. Sutherby K, Szrnukler G, Halpern A, Alexander M, Thornicroft G, Johnson C, Wright S. A study of ‘crisis cards’ in a community psychiatric service. Acta Psychiatr Scand. 1999;100:56–61.
    1. Henderson C, Flood C, Leese M, Thornicroft G, Sutherby K, Szmukler G. Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMj. 2004;329:136–138. doi: 10.1136/bmj.38155.585046.63.
    1. Lysaker PH, Buck KD. Is recovery from schizophrenia possible? an overview of concepts, evidence, and clinical implications. Primary Psychiatry. 2008;15:60–65.
    1. Silverstein SM, Bellack AS. A scientific agenda for the concept of recovery as it applies to schizophrenia. Clin Psychol Rev. 2008;28:1108–1124. doi: 10.1016/j.cpr.2008.03.004.

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