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Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial

Published online by Cambridge University Press:  11 February 2022

Christy Lai Ming Hui Open the ORCID record for Christy Lai Ming Hui [Opens in a new window] ,
Andreas Kar Hin Wong ,
Elise Chun Ning Ho Open the ORCID record for Elise Chun Ning Ho [Opens in a new window] ,
Bertha Sze Ting Lam ,
Priscilla Wing Man Hui Open the ORCID record for Priscilla Wing Man Hui [Opens in a new window] ,
Tiffany Junchen Tao ,
Wing Chung Chang Open the ORCID record for Wing Chung Chang [Opens in a new window] ,
Sherry Kit Wa Chan Open the ORCID record for Sherry Kit Wa Chan [Opens in a new window] ,
Edwin Ho Ming Lee Open the ORCID record for Edwin Ho Ming Lee [Opens in a new window]  and
Yi Nam Suen Open the ORCID record for Yi Nam Suen [Opens in a new window]
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Christy Lai Ming Hui
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Andreas Kar Hin Wong
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Elise Chun Ning Ho
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Bertha Sze Ting Lam
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Priscilla Wing Man Hui
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Tiffany Junchen Tao
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Wing Chung Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
Sherry Kit Wa Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
Edwin Ho Ming Lee
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Yi Nam Suen
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
May Mei Ling Lam
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Cindy Pui Yu Chiu
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Frendi Wing Sai Li
Affiliation:
Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
Kwok Fai Leung
Affiliation:
Department of Occupational Therapy, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
Sarah M. McGhee
Affiliation:
School of Public Health, University of Hong Kong, Pok Fu Lam, Hong Kong
Chi Wing Law
Affiliation:
Department of Psychiatry, Queen Mary Hospital, Pok Fu Lam, Hong Kong
Dicky Wai Sau Chung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Tai Po, Hong Kong
Wai Song Yeung
Affiliation:
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
Michael Gar Chung Yiu
Affiliation:
Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
Edwin Pui Fai Pang
Affiliation:
Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
Steve Tso
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
Simon Sai Yu Lui
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
Se Fong Hung
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
Wing King Lee
Affiliation:
Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
Ka Chee Yip
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Ka Lik Kwan
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Roger Man Kin Ng
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Pak Chung Sham
Affiliation:
State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong Department of Psychiatry, King's College London, London, UK
William G. Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, Canada
Eric Yu Hai Chen*
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
*
Author for correspondence: Eric Yu Hai Chen, E-mail: ericchen.hku@gmail.com
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Abstract

Background

Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.

Methods

360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.

Results

Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.

Conclusions

Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.

Keywords

Adult-onsetearly interventioneffectivenessfunctional outcomepsychosissymptoms
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 6 , April 2023 , pp. 2339 - 2351
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Copyright
Copyright © University of Hong Kong, 2022. Published by Cambridge University Press

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References

Addington, D., Addington, J., Maticka-Tyndale, E., & Joyce, J. (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research, 6(3), 201–208.CrossRefGoogle ScholarPubMed
Albert, N., Melau, M., Jensen, H., Emborg, C., Jepsen, J. R. M., Fagerlund, B., … Nordentoft, M. (2017a). Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first-episode psychosis: Randomised, superiority, parallel-group trial in Denmark (OPUS II). British Medical Journal, 356, i6681.CrossRefGoogle ScholarPubMed
Albert, N., Melau, M., Jensen, H., Hastrup, L. H., Hjorthøj, C., & Nordentoft, M. (2017b). The effect of duration of untreated psychosis and treatment delay on the outcomes of prolonged early intervention in psychotic disorders. NPJ Schizophrenia, 3(1), 1–8.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Andreasen, N. C. (1983). The scale for the assessment of negative symptoms (SANS). Iowa City: University of Iowa.Google Scholar
Andreasen, N. C. (1984). Scale for the assessment of positive symptoms (SAPS). Iowa City: University of Iowa.Google Scholar
Barnes, T. R. (1989). A rating scale for drug-induced akathisia. The British Journal of Psychiatry, 154(5), 672–676.CrossRefGoogle ScholarPubMed
Bertelsen, M., Jeppesen, P., Petersen, L., Thorup, A., Øhlenschlæger, J., Le Quach, P., … Nordentoft, M. (2008). 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. Archives of General Psychiatry, 65(7), 762–771.CrossRefGoogle ScholarPubMed
Birchwood, M., Todd, P., & Jackson, C. (1998). Early intervention in psychosis. The British Journal of Psychiatry, 172(S33), 53–59.Google ScholarPubMed
Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010). Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: Systematic review. The British Journal of Psychiatry, 197(5), 350–356.CrossRefGoogle ScholarPubMed
Bottlender, R., Sato, T., Jäger, M., Wegener, U., Wittmann, J., Strauß, A., & Möller, H. J. (2003). The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophrenia Research, 62(1-2), 37–44.CrossRefGoogle ScholarPubMed
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8(3), 470–484.CrossRefGoogle ScholarPubMed
Chang, W. C., Chan, G. H. K., Jim, O. T. T., Lau, E. S. K., Hui, C. L. M., Chan, S. K. W., … Chen, E. Y. H. (2015). Optimal duration of an early intervention programme for first-episode psychosis: Randomised controlled trial. The British Journal of Psychiatry, 206(6), 492–500.CrossRefGoogle ScholarPubMed
Chang, W. C., Kwong, V. W. Y., Lau, E. S. K., So, H. C., Wong, C. S. M., Chan, G. H. K., … Chen, E. Y. H. (2017). Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis. The British Journal of Psychiatry, 211(1), 37–44.CrossRefGoogle ScholarPubMed
Chen, E. Y., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., … Honer, W. G. (2011). Three-year outcome of phase-specific early intervention for first-episode psychosis: A cohort study in Hong Kong. Early Intervention in Psychiatry, 5(4), 315–323.CrossRefGoogle ScholarPubMed
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., … Kane, J. M. (2018). Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry, 75(6), 555–565.CrossRefGoogle ScholarPubMed
Foerster, A., Lewis, S., Owen, M., & Murray, R. (1991). Pre-morbid adjustment and personality in psychosis: Effects of sex and diagnosis. The British Journal of Psychiatry, 158(2), 171–176.CrossRefGoogle ScholarPubMed
Global Burden of Disease Study 2013 Collaborators. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the global burden of disease study 2013. Lancet, 386 (9995), 743–800.CrossRefGoogle Scholar
Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992). Revising axis V for DSM-IV: A review of measures of social functioning. American Journal of Psychiatry, 149(9), 1148–1156.Google ScholarPubMed
Goodman, S. H., Sewell, D. R., Cooley, E. L., & Leavitt, N. (1993). Assessing levels of adaptive functioning: The role functioning scale. Community Mental Health Journal, 29(2), 119–131.CrossRefGoogle ScholarPubMed
Guy, W. (1976). ECDEU assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs.Google Scholar
Häfner, H., Maurer, K., Löffler, W., & Riecher-Rössler, A. (1993). The influence of age and sex on the onset and early course of schizophrenia. The British Journal of Psychiatry, 162(1), 80–86.CrossRefGoogle ScholarPubMed
Häfner, H., Riecher-Rössler, A., Hambrecht, M., Maurer, K., Meissner, S., Schmidtke, A., … van der Heiden, W. (1992). IRAOS: An instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research, 6(3), 209–223.CrossRefGoogle ScholarPubMed
Hui, C. L., Chang, W. C., Chan, S. K., Lee, E. H., Tam, W. W., Lai, D. C., … Chen, E. Y. (2014). Early intervention and evaluation for adult-onset psychosis: The JCEP study rationale and design. Early Intervention in Psychiatry, 8(3), 261–268.CrossRefGoogle ScholarPubMed
Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Rosenheck, R. A., … Heinssen, R. K. (2016). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. American Journal of Psychiatry, 173(4), 362–372.CrossRefGoogle ScholarPubMed
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276.CrossRefGoogle ScholarPubMed
Lasalvia, A., Bonetto, C., Lenzi, J., Rucci, P., Iozzino, L., & Cellini, M., … GET UP Group. (2017). Predictors and moderators of treatment outcome in patients receiving multi-element psychosocial intervention for early psychosis: Results from the GET UP pragmatic cluster randomised controlled trial. The British Journal of Psychiatry, 210(5), 342–349.CrossRefGoogle ScholarPubMed
Leckman, J. F., Sholomskas, D., Thompson, D., Belanger, A., & Weissman, M. M. (1982). Best estimate of lifetime psychiatric diagnosis: A methodological study. Archives of General Psychiatry, 39(8), 879–883.CrossRefGoogle ScholarPubMed
Lingjaerde, O., Ahlfors, U. G., Bech, P., Dencker, S. J., & Elgen, K. (1987). The UKU side effect rating scale: A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica, 76 (Suppl 344), 1–100.CrossRefGoogle Scholar
Malla, A., Joober, R., Iyer, S., Norman, R., Schmitz, N., Brown, T., … Abadi, S. (2017). Comparing three-year extension of early intervention service to regular care following two years of early intervention service in first-episode psychosis: A randomized single-blind clinical trial. World Psychiatry, 16(3), 278–286.CrossRefGoogle ScholarPubMed
Malla, A., Shah, J., Dama, M., Iyer, S., Joober, R., Abdel-Baki, A., & Abadi, S. (2018). Delay in initial treatment may limit the benefit of even extended early intervention service: Results from a RCT. Early Intervention in Psychiatry, 12 (Suppl 1), 23.Google Scholar
McGlashan, T. H. (2006). Schizophrenia in translation: Is active psychosis neurotoxic?. Schizophrenia Bulletin, 32(4), 609–613.CrossRefGoogle Scholar
Nurmi, J. E. (1992). Age differences in adult life goals, concerns, and their temporal extension: A life course approach to future-oriented motivation. International Journal of Behavioral Development, 15(4), 487–508.CrossRefGoogle Scholar
Pearlson, G. D., Kreger, L., Rabins, P. V., Chase, G. A., Cohen, B., Wirth, J. B., … Tune, L. E. (1989). A chart review study of late-onset and early-onset schizophrenia. American Journal of Psychiatry, 146(12), 1568–1574.Google ScholarPubMed
Pedersen, C. B., Mors, O., Bertelsen, A., Waltoft, B. L., Agerbo, E., McGrath, J. J., … Eaton, W. W. (2014). A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry, 71(5), 573–581.CrossRefGoogle ScholarPubMed
Penttilä, M., Jääskeläinen, E., Hirvonen, N., Isohanni, M., & Miettunen, J. (2014). Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: Systematic review and meta-analysis. The British Journal of Psychiatry, 205(2), 88–94.CrossRefGoogle ScholarPubMed
Radhakrishnan, M., McCrone, P., Lafortune, L., Everard, L., Fowler, D., Amos, T., … Birchwood, M. (2018). Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Intervention in Psychiatry, 12(4), 747–756.CrossRefGoogle ScholarPubMed
Shamsi, S., Lau, A., Lencz, T., Burdick, K. E., DeRosse, P., Brenner, R., … Malhotra, A. K. (2011). Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophrenia Research, 126(1-3), 257–264.CrossRefGoogle ScholarPubMed
Simpson, G. M., & Angus, J. W. S. (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica, 45(S212), 11–19.CrossRefGoogle Scholar
Singh, S. P. (2007). Outcome measures in early psychosis: Relevance of duration of untreated psychosis. The British Journal of Psychiatry, 191(S50), s58–s63.CrossRefGoogle Scholar
Ware, J. E. Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefGoogle ScholarPubMed
Wrzus, C., Hänel, M., Wagner, J., & Neyer, F. J. (2013). Social network changes and life events across the life span: A meta-analysis. Psychological Bulletin, 139(1), 53.CrossRefGoogle ScholarPubMed
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. The British Journal of Psychiatry, 133(5), 429–435.CrossRefGoogle ScholarPubMed
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