Early Intervention for First Episode Psychosis Produces Long-Term Benefits

Individuals with first-episode psychosis who participated in a comprehensive, team-based treatment program experienced fewer symptoms, better quality of life, and fewer inpatient hospital days over five years than those who received usual care in the community, according to a report in Schizophrenia Bulletin.

The results were from a five-year follow-up of patients enrolled in NIMH’s Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP). The comprehensive treatment program tested in RAISE was called NAVIGATE, which includes four core interventions: personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment and education.

Previous studies found that patients who participated in NAVIGATE showed greater symptom improvements and quality of life compared with those who received standard community care over the first two years of treatment. The new results demonstrate longer-term benefits of NAVIGATE compared with community care, wrote lead author Delbert G. Robinson, M.D., of The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and colleagues.

The researchers compared data on 223 patients at 17 community sites enrolled in NAVIGATE and 181 patients at 17 sites receiving usual care. The primary outcomes were quality of life, as measured by the Heinrichs-Carpenter Quality of Life Scale (QLS); positive and negative symptoms of psychosis, as measured by the Positive and Negative Syndrome Scale (PANSS); and hospital inpatient days.

Assessments occurred every six months; 61% of participants had assessments conducted for at least two years, and 31% had assessments conducted at five years. Overall, the most common causes of dropout recorded by sites were lost to follow-up (34%) followed by declined assessments (10%) and moving out of area (10%), Robinson and colleagues noted.

On average, NAVIGATE participants improved by 7.73 points more than standard care group on PANSS and 13.14 points more than the standard care group on the QLS over the five-year period. They also had 2.53 fewer hospitalization days over five years than those in usual care treatment. The difference in hospitalization days “may be small from an individual perspective but substantial from a policy perspective when considered across many individuals in large scale initiatives,” the researchers wrote.

“[T]he data support long-term benefit of NAVIGATE compared to community care. These benefits are important for making individual decisions about treatment and for policy decisions about program development, implementation, and support.”

For more information, see the Psychiatric News article “Early Psychosis Intervention Shows Robust Real-World Effectiveness.”

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