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

Autor: Christy Lai Ming Hui, Andreas Kar Hin Wong, Elise Chun Ning Ho, Bertha Sze Ting Lam, Priscilla Wing Man Hui, Tiffany Junchen Tao, Wing Chung Chang, Sherry Kit Wa Chan, Edwin Ho Ming Lee, Yi Nam Suen, May Mei Ling Lam, Cindy Pui Yu Chiu, Frendi Wing Sai Li, Kwok Fai Leung, Sarah M. McGhee, Chi Wing Law, Dicky Wai Sau Chung, Wai Song Yeung, Michael Gar Chung Yiu, Edwin Pui Fai Pang, Steve Tso, Simon Sai Yu Lui, Se Fong Hung, Wing King Lee, Ka Chee Yip, Ka Lik Kwan, Roger Man Kin Ng, Pak Chung Sham, William G. Honer, Eric Yu Hai Chen
Rok vydání: 2022
Předmět:
Zdroj: Psychological Medicine. 53:2339-2351
ISSN: 1469-8978
0033-2917
DOI: 10.1017/s0033291721004189
Popis: BackgroundContrasting 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.Methods360 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.ResultsCompared 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.ConclusionsSpecialized 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.
Databáze: OpenAIRE
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