Benefits of early intervention in psychosis not sustained at five years

Benefits from assertive early intervention in first-episode psychosis are not sustained after patients move to standard care, five-year results from the Danish OPUS program have shown. A clinical trial randomised 547 patients to standard treatment or to participation in a program that provided assertive community treatment, psychoeducational family treatment, and social skills training. Intensive treatment was provided for two years. At the end of this period, the OPUS patients had less severe psychotic and negative symptoms, less secondary substance abuse, better treatment adherence, greater success with lower doses of antipsychotics, and higher satisfaction with treatment. About 56% of patients were available for reassessment five years after the start of the study. There was no difference between OPUS and standard-care patients in the severity of their psychotic or negative symptoms — the primary outcome measures for the study. However, OPUS patients were less likely to be living in supported housing (4% vs 10%) and had spent less total time in hospital (149 vs 193 days). There were no differences in other secondary outcomes at five years, including the prevalence of depression, substance abuse and suicidal behaviour, the use of antipsychotic medication, the proportion who were working or being educated (about 60%) or the proportion in remission. About 15% in both groups experienced an episodic course of illness, 45% had continuous symptoms, and 40% were not psychotic in the final two years of follow-up. “Our results give rise to questions about how long early-intervention services should be offered to patients to maintain good clinical and social outcomes,” the researchers said. “Second, this trial pinpoints the intrinsic problem of...how to make the transition to normal life as gentle as possible for those patients who no longer need treatment, or who need a less intensive treatment program, while at the same time maintaining continuous treatment for those who develop a chronic course of illness.” More research would be needed to define the optimal duration of intensive intervention, the elements of the treatment package that were most effective, and the characteristics of patients who were most likely to benefit. Reference...