Early Intervention Services Superior to Treatment as Usual for Early-Phase Psychosis

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Early intervention service programs endeavor to reduce symptoms of psychosis, improve functional outcomes, and decrease long-term disability.
Early intervention service programs endeavor to reduce symptoms of psychosis, improve functional outcomes, and decrease long-term disability.

Early intervention services are associated with better outcomes than treatment as usual in early-phase psychosis, according to a meta-analysis published in JAMA Psychiatry.

Treatment outcomes in schizophrenia are disappointing, and the disorder is associated with a high degree of disability and substantial personal and societal costs. Median recovery is only 13.5%, and individuals with schizophrenia die on average 15 to 20 years earlier than the general population. Patients with early-phase disease generally respond better to treatment, and there has been a focus on early identification and optimized intervention.Early intervention service programs endeavor to reduce symptoms of psychosis, improve functional outcomes, and decrease long-term disability. 

However, to date there has been only 1 meta-analysis covering only 4 randomized trials comparing early intervention services with treatment as usual in early-phase psychosis. The investigators undertook the current meta-analysis to include more recently published trials.

Christoph U. Correl, MD, of the Department of Psychiatry at The Zucker Hillside Hospital, Northwell Health in Glen Oaks, New York, and colleagues performed a systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov through June 6, 2017 and identified 10 randomized clinical trials comparing early intervention services with treatment as usual in first-episode psychosis or early-phase schizophrenia spectrum disorders. This systematic review and meta-analysis was conducted according to PRISMA guidelines.

The trials had a mean duration of 16.2 months and a total patient population of 2176, with a mean age of 27.5; 62% were male. Early intervention services were associated with better outcomes than treatment as usual at the end of the treatment for all 13 meta-analyzable outcomes. The risk ratio (RR) for all-cause treatment discontinuation for early intervention services vs treatment as usual was 0.70 (P <.001), indicating benefit.

Other outcomes also demonstrated benefit for early intervention services compared with treatment as usual: at least 1 psychiatric hospitalization (RR, 0.74; P =.003), involvement in school or work (RR, 1.13; P =.01), total symptom severity (standardized mean difference [SMD], −0.32; P <.001), positive symptom severity (SMD, −0.22; P <.001), and negative symptom severity (SMD, −0.28; P <.001). With the exception of general symptom severity and depressive symptom severity at 18 to 24 months, benefit was seen for all outcomes for early intervention services at 6, 9 to 12, and 18 to 24 months of treatment.

The modest number of trials and patients included and the heterogeneity usually inherent to such analyses were limits to the current review.

The investigators argued that given the high degree of personal distress and societal costs, the superior benefit provided by early intervention services could be cost-effective, and they call for widespread implementation and funding of early intervention services in the United States and globally.

Reference

Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression [published online May 2, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0623

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