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JAMA Psychiatry. 2018 Jun 1;75(6):555-565. doi: 10.1001/jamapsychiatry.2018.0623.

Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression.

Author information

1
Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York.
2
Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York.
3
The Feinstein Institute for Medical Research, Manhasset, New York.
4
Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
5
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
6
Institute of Psychiatry, King's College London, London, England.
7
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
8
The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark.
9
Department of Psychiatry, Yale University, New Haven, Connecticut.
10
Specialized Treatment Early in Psychosis (STEP) Program, Connecticut Mental Health Center, New Haven.
11
Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands.
12
Department of Psychiatry, University of Hong Kong, Hong Kong, China.
13
State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, Hong Kong, China.
14
Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico.
15
Department of Psychiatry, SUNY Downstate Medical Center, New York, New York.
16
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth, New Hampshire.
17
Bureau of Behavioral Health, College of Health and Human Services (CHHS), Dartmouth, New Hampshire.
18
Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.
19
Department of Psychiatry, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.
20
Department of Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.
21
Department of Epidemiology, Yale University, New Haven, Connecticut.
22
Department of Public Health, Yale University, New Haven, Connecticut.
23
The Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
24
Department of Social Medicine, The University of North Carolina at Chapel Hill.
25
Nathan Kline Institute, Orangeburg, New York.
26
Department of Psychology, The University of North Carolina at Chapel Hill.
27
National Institute of Mental Health (NIMH), Bethesda, Maryland.

Abstract

Importance:

The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal.

Objective:

To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis.

Data Sources:

Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017.

Study Selection:

Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders.

Data Extraction and Synthesis:

This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses.

Main Outcomes and Measures:

The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period.

Results:

Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months).

Conclusions and Relevance:

In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.

PMID:
29800949
PMCID:
PMC6137532
[Available on 2019-05-02]
DOI:
10.1001/jamapsychiatry.2018.0623

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