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EPA-1816 - Intervention in First Episode Psychosis

Published online by Cambridge University Press:  15 April 2020

M. Nordentoft ,
M. Melau ,
J. Rasmussen ,
A. Thorup ,
G. Secher ,
S. Austin ,
P. Jeppesen ,
O. Mors ,
P. Lone  and
M. Bertelsen
M. Nordentoft
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
M. Melau
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
J. Rasmussen
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
A. Thorup
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
G. Secher
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
S. Austin
Affiliation:
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
P. Jeppesen
Affiliation:
Child and Adolescent Center, University of Copenhagen, Copenhagen, Denmark
O. Mors
Affiliation:
Center for Psychiatric Research, University of Aarhus, Aarhus, Denmark
P. Lone
Affiliation:
Mental Health Center Ballerup, University of Copenhagen, Copenhagen, Denmark
M. Bertelsen
Affiliation:
Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

Abstract

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Purpose of review

It has been hypothesized that the first five years after first episode of psychosis constitutes a critical period in with opportunities for ameliorating the course of illness. Based on this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions.

Recent findings

The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials such as the Lambeth Early Onset (LEO) trial, the Croydon Outreach and Assertive Support Team COAST trial and the Norwegian site of Optimal Treatment (OTP) trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred back to standard treatment. However the positive effects on service use and ability to live independently seem to be durable.

Summary

Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing two years of intervention with extended treatment periods.

Two-year follow-up N=369
 OPUS (N=205)ST (N=164)PCohen’s d
Psychotic dimension1.06 (1.26)1.27 (1.40)0.020.16
Negative dimension1.41 (1.15)1.82 (1.23)<0.0010.34
GAF function55.16 (15.15)51.13 (15.92)0.030.26
User satisfaction26.1 (3.7)22.9 (5.2)<0.0010.67

Type
CS04 - Update on Interventions for Patients with Schizophrenia
Information
European Psychiatry , Volume 29 , Issue S1: Abstracts of the 22nd European Congress of Psychiatry , 2014 , pp. 1
Copyright
Copyright © European Psychiatric Association 2014
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