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10-year outcome study of an early intervention program for psychosis compared with standard care service

Published online by Cambridge University Press:  19 September 2014

S. K. W. Chan ,
H. C. So ,
C. L. M. Hui ,
W. C. Chang ,
E. H. M. Lee ,
D. W. S. Chung ,
S. Tso ,
S. F. Hung ,
K. C. Yip  and
E. Dunn
...Show all authors
S. K. W. Chan*
Affiliation:
Department of Psychiatry, The University of Hong Kong, Hong Kong
H. C. So
Affiliation:
Department of Psychiatry, Queen Mary Hospital, Hong Kong
C. L. M. Hui
Affiliation:
Department of Psychiatry, The University of Hong Kong, Hong Kong
W. C. Chang
Affiliation:
Department of Psychiatry, The University of Hong Kong, Hong Kong
E. H. M. Lee
Affiliation:
Department of Psychiatry, The University of Hong Kong, Hong Kong
D. W. S. Chung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong
S. Tso
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Hong Kong
S. F. Hung
Affiliation:
Department of Psychiatry, Kwai Chung Hospital, Hong Kong
K. C. Yip
Affiliation:
Department of Psychiatry, Kowloon Hospital, Hong Kong
E. Dunn
Affiliation:
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
E. Y. H. Chen
Affiliation:
Department of Psychiatry, The University of Hong Kong, Hong Kong The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
*
*Address for correspondence: Dr S. K. W. Chan, Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Room 219, New Clinical Building, 102 Pokfulam Road, Hong Kong. (Email: kwsherry@hku.hk)
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Abstract

Background.

Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.

Method.

Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.

Results.

Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.

Conclusions.

The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.

Keywords

Early interventionpsychosis10-year outcomes
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 6 , April 2015 , pp. 1181 - 1193
Copyright
Copyright © Cambridge University Press 2014 

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References

Abdullah, ASM, Fielding, R, Hedley, AJ (2002). Patterns of cigarette smoking, alcohol use and other substance use among Chinese university students in Hong Kong. American Journal on Addictions 11, 235–246.CrossRefGoogle ScholarPubMed
Addington, D, Addington, J, Maticka-Tyndale, E, Joyce, J (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research 6, 201–208.CrossRefGoogle ScholarPubMed
Addington, J, Addington, D (2008). Outcome after discharge from an early psychosis program. Schizophrenia Research 106, 363–366.CrossRefGoogle ScholarPubMed
Agius, M, Shah, S, Ramkisson, R, Murphy, S, Zaman, R (2007). Three year outcomes of an early intervention for psychosis service as compared with treatment as usual for first psychotic episodes in a standard community mental health team. Preliminary results. Psychiatria Danubina 19, 10–19.Google Scholar
Andreasen, N (1983). Scale for the Assessment of Negative Symptoms. University of Iowa: Iowa City.Google Scholar
Andreasen, NC, Carpenter, WT, Kane, JM, Lasser, RA, Marder, SR, Weinberger, DR (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.CrossRefGoogle ScholarPubMed
APA & APA Task Force on DSM-IV (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Austin, SF, Mors, O, Secher, RG, Hjorthoj, CR, Albert, N, Bertelsen, M, Jensen, H, Jeppesen, P, Petersen, L, Randers, L, Thorup, A, Nordentoft, M (2013). Predictors of recovery in first episode psychosis: the OPUS cohort at 10 year follow-up. Schizophrenia Research 150, 163–168.CrossRefGoogle Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, 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, 762–771.CrossRefGoogle ScholarPubMed
Bertolote, J, McGorry, P (2005). Early intervention and recovery for young people with early psychosis: consensus statement. British Journal of Psychiatry 187, s116–s119.CrossRefGoogle Scholar
Birchwood, M, Fiorillo, A (2000). The critical period for early intervention. American Journal of Psychiatric Rehabilitation 4, 182–198.Google Scholar
Bosanac, P, Patton, G, Castle, D (2010). Early intervention in psychotic disorders: faith before facts? Psychological Medicine 40, 353–358.CrossRefGoogle ScholarPubMed
Bottlender, R, Strauß, A, Möller, HJ (2010). Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission. Schizophrenia Research 116, 9–15.CrossRefGoogle ScholarPubMed
Chen, E (2004). Developing an early intervention service in Hong Kong. In Best Care in Early Psychosis Intervention: Global Perspectives (ed. Ehmann, T., MacEvan, G. W. and Honer, W. G.), pp. 125–130. Taylor & Francis: New York.Google Scholar
Chen, EYH, Tang, JYM, Hui, CLM, Chiu, CPY, Lam, MML, Law, CW, Yew, CWS, Wong, GHY, Chung, DWS, Tso, S (2011). Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Intervention in Psychiatry 5, 315–323.CrossRefGoogle ScholarPubMed
Collins, PY, Patel, V, Joestl, SS, March, D, Insel, TR, Daar, AS, Bordin, IA, Costello, EJ, Durkin, M, Fairburn, C (2011). Grand challenges in global mental health. Nature 475, 27–30.CrossRefGoogle ScholarPubMed
Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067.CrossRefGoogle ScholarPubMed
Crumlish, N, Whitty, P, Clarke, M, Browne, S, Kamali, M, Gervin, M, McTigue, O, Kinsella, A, Waddington, JL, Larkin, C (2009). Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. British Journal of Psychiatry 194, 18–24.CrossRefGoogle ScholarPubMed
First, MB (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders SCID-I: Clinician Version. American Psychiatric Publishing Inc.: Washington, DC.Google Scholar
Gafoor, R, Nitsch, D, McCrone, P, Craig, TKJ, Garety, PA, Power, P, McGuire, P (2010). Effect of early intervention on 5-year outcome in non-affective psychosis. British Journal of Psychiatry 196, 372–376.CrossRefGoogle ScholarPubMed
Gardner, DM, Murphy, AL, O'Donnell, H, Centorrino, F, Baldessarini, RJ (2010). International consensus study of antipsychotic dosing. American Journal of Psychiatry 167, 686–693.CrossRefGoogle ScholarPubMed
Goodman, SH, Sewell, DR, Cooley, EL, Leavitt, N (1993). Assessing levels of adaptive functioning: the Role Functioning Scale. Community Mental Health Journal 29, 119–131.CrossRefGoogle ScholarPubMed
Haro, J, Kamath, S, Ochoa, S, Novick, D, Rele, K, Fargas, A, Rodriguez, M, Rele, R, Orta, J, Kharbeng, A (2003). The Clinical Global Impression–Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scandinavica 107, 16–23.CrossRefGoogle Scholar
Haro, JM, Novick, D, Bertsch, J, Karagianis, J, Dossenbach, M, Jones, PB (2011). Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. British Journal of Psychiatry 199, 194–201.CrossRefGoogle ScholarPubMed
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J, Dube, K, Ganev, K, Giel, R, Der Heiden, WAN (2001). Recovery from psychotic illness: a 15-and 25-year international follow-up study. British Journal of Psychiatry 178, 506–517.CrossRefGoogle Scholar
Harrow, M, Grossman, LS, Jobe, TH, Herbener, ES (2005). Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study. Schizophrenia Bulletin 31, 723–734.CrossRefGoogle ScholarPubMed
Harvey, P, Lepage, M, Malla, A (2007). Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a metaanalytic approach. Canadian Journal of Psychiatry 52, 464–472.CrossRefGoogle ScholarPubMed
Hegelstad, WT, Larsen, TK, Auestad, B, Evensen, J, Haahr, U, Joa, I, Johannesen, JO, Langeveld, J, Melle, I, Opjordsmoen, S, Rossberg, JI, Rund, BR, Simonsen, E, Sundet, K, Vaglum, P, Friis, S, McGlashan, T (2012). Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. American Journal of Psychiatry 169, 374–380.CrossRefGoogle ScholarPubMed
Hui, C, Wong, G, Lam, Y, Chow, P, Chen, E (2008). Patient-clinician communication and needs identification for outpatients with schizophrenia in Hong Kong: role of the 2-COM instrument. Hong Kong Journal of Psychiatry 18, 69–75.Google Scholar
Kay, S, Flszbein, A, Opfer, L (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Lam, MM, Pearson, V, Ng, RM, Chiu, CP, Law, CW, Chen, EY (2011). What does recovery from psychosis mean? Perceptions of young first-episode patients. International Journal of Social Psychiatry 57, 580–587.CrossRefGoogle ScholarPubMed
Larsen, TK, Melle, I, Friis, S, Joa, I, Johannessen, JO, Opjordsmoen, S, Simonsen, E, Vaglum, P, McGlashan, TH (2007). One-year effect of changing duration of untreated psychosis in a single catchment area. British Journal of Psychiatry 191, S128–S132.CrossRefGoogle Scholar
Malla, A, Norman, R, McLean, T, Scholten, D, Townsend, L (2003). A Canadian programme for early intervention in non-affective psychotic disorders. Australian and New Zealand Journal of Psychiatry 37, 407–413.CrossRefGoogle ScholarPubMed
Marshall, M, Rathbone, J (2011). Early intervention for psychosis. Cochrane Database of Systematic Reviews. Art. no. CD004718. doi:10.1002/14651858.CD004718.pub3. CrossRefGoogle Scholar
McCrone, P, Craig, T, Power, P, Garety, P (2010). Cost-effectiveness of an early intervention service for people with psychosis. British Journal of Psychiatry 196, 377–382.CrossRefGoogle ScholarPubMed
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305–326.CrossRefGoogle ScholarPubMed
Melle, I, Larsen, TK, Haahr, U, Friis, S, Johannesen, JO, Opjordsmoen, S, Rund, BR, Simonsen, E, Vaglum, P, McGlashan, T (2008). Prevention of negative symptom psychopathologies in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis. Archives of General Psychiatry 65, 634–640.CrossRefGoogle ScholarPubMed
Mihalopoulos, C, Harris, M, Henry, L, Harrigan, S, McGorry, P (2009). Is early intervention in psychosis cost-effective over the long term? Schizophrenia Bulletin 35, 909–918.CrossRefGoogle ScholarPubMed
Nordentoft, M, Rasmussen, JO, Melau, M, Hjorthoj, CR, Thorup, AA (2014). How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Current Opinion in Psychiatry 27, 167–172.CrossRefGoogle ScholarPubMed
Norman, RMG, Manchanda, R, Malla, AK, Windell, D, Harricharan, R, Northcott, S (2011). Symptom and functional outcomes for a 5 year early intervention program for psychoses. Schizophrenia Research 129, 111–115.CrossRefGoogle ScholarPubMed
Petersen, L, Nordentoft, M, Jeppesen, P, OHLENSCHLAeGER, J, Thorup, A, Christensen, T, Krarup, G, Dahlstrom, J, Haastrup, B, Jorgensen, P (2005). Improving 1-year outcome in first-episode psychosis: OPUS trial. British Journal of Psychiatry 187, s98–s103.CrossRefGoogle Scholar
Singh, SP (2010). Early intervention in psychosis. British Journal of Psychiatry 196, 343–345.CrossRefGoogle ScholarPubMed
Strauss, GP, Harrow, M, Grossman, LS, Rosen, C (2010). Periods of recovery in deficit syndrome schizophrenia: a 20-year multi-follow-up longitudinal study. Schizophrenia Bulletin 36, 788–799.CrossRefGoogle ScholarPubMed
Strauss, JS, Carpenter, WT Jr. (1972). The prediction of outcome in schizophrenia. I. Characteristics of outcome. Archives of General Psychiatry 27, 739–746.CrossRefGoogle ScholarPubMed
Tang, JYM, Wong, GHY, Hui, CLM, Lam, MML, Chiu, CPY, Chan, SKW, Chung, DWS, Tso, S, Chan, KPM, Yip, K (2010). Early intervention for psychosis in Hong Kong – the EASY programme. Early Intervention in Psychiatry 4, 214–219.CrossRefGoogle Scholar
Wiersma, D, Wanderling, J, Dragomirecka, E, Ganev, K, Harrison, G, An Der Heiden, W, Nienhuis, F, Walsh, D (2000). Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres. Psychological Medicine 30, 1155–1167.CrossRefGoogle ScholarPubMed
Wong, GHY, Hui, CLM, Chiu, CPY, Lam, M, Chung, DWS, Tso, S, Chan, K, Yip, K, Hung, S, Chen, EYH (2008). Early detection and intervention of psychosis in Hong Kong: experience of a population-based intervention programme. Clinical Neuropsychiatry 5, 286–289.Google Scholar
Wong, KK, Chan, SKW, Lam, MM, Hui, CL, Hung, SF, Tay, M, Lee, K, Chen, EYH (2011). Cost-effectiveness of an early assessment service for young people with early psychosis in Hong Kong. Australian and New Zealand Journal of Psychiatry 45, 673–680.CrossRefGoogle ScholarPubMed
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