Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis

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A randomised controlled trial of extended 1-year specialised case management for patients presenting with first-episode psychosis to early intervention Programme in Hong Kong

Regular Symposium 2.2 – Early Psychosis: no. RS2.2.2Congress Theme: Yin and Yang of Mental Health in Asia - Balancing PolaritiesBACKGROUND: Specialised early intervention (EI) service has been shown to be effective in improving short-term outcome of psychosis but such initial therapeutic benefits could not be maintained after service termination. Most EI services offer 2-year treatment and there is a paucity of data regarding effectiveness of longer-term EI service for psychosis. METHODS: This randomised single-blind controlled trial (RCT) [trial registered with ClinicalTrials.gov: NCT01202357] aimed to compare extended 1-year EI service (EI group, i.e. 3-year EI service, n = 82) comprising continuing phase-specific case management with step-down standard care service (SC group, i.e. 2-year EI service, n = 78) in 160 Chinese patients who had received 2-year intensive EI service for first-episode psychosis in Hong Kong. Participants were assessed at study entry, and 6 and 12 months of follow-up. Primary outcome was functioning. Outcome analyses were performed on intention-to-treat basis. RESULTS: No significant between-group differences in socio-demographics, discontinuation rate, treatment characteristics, and baseline clinical and functional measures were noted. By the end of 12-month follow-up, EI group had significantly better outcomes than SC group in global functioning and various specific functional dimensions including work productivity, independent living skills, and social relationship. Participants in EI group had significantly fewer negative and depressive symptoms, and lower outpatient default rate than those in SC group. Longitudinal analyses revealed differential trajectories of functioning between treatment groups with EI but not SC group showing sustained and progressive functional improvement over 12 months. CONCLUSION: This study is the first to provide empirical supportive evidence to extending specialised EI service for psychosis beyond 2 years using RCT design. Further follow-up is required to clarify the sustainability of treatment effects of this extended 1-year early intervention.link_to_OA_fulltex

Effects of extended case management on functioning in people with early psychosis- Preliminary findings of the easy3 randomised controlled study

Background: The Early Assessment Service for Young People with psychosis (EASY) in Hong Kong provides case management to first-episode psychosis patients for the first 2 years of treatment. However, clinically, the first few years of illness are still eventful, and theoretically, within the critical period that determines long-term outcomes. This study aims at investigating the optimal duration of early intervention for patients with early psychosis. Methods: One hundred and sixty EASY patients who had received 2 years of case management were stratified and randomised to receiving either an additional year (in total 3 years) of case management (CM) or standard care (SC). Symptom and functioning outcomes are compared at 6 months and 1 year after recruitment. Results: At this stage, 2 patients dropped out from the study (1 was transferred to another clinic and 1 requested to withdraw from the study during a relapse of psychotic symptoms). At baseline, there is no significant difference between the CM (n=80) and SC (n=78) groups in age (CM 23.00±3.08, SC 22.74±3.32years), gender, education, and duration of untreated psychosis (CM 60.00; IQR 17.50 to 314.50days, SC 90.00; IQR 14.00 to 333.00days). The two groups did not differ in terms of symptoms and social and occupational functioning (SOFAS, out of 100) and role functioning (out of 7) at baseline. Patients showed moderate difficulty (CM 57.66±14.28, SC 57.99±13.69) in general social and occupational functioning, marginal functioning in work productivity (CM 4.11±1.79, SC 4.60±1.52) and extended social relationships (CM 4.16±1.40, SC 3.99±1.49), and moderate functioning in independent living (CM 6.05±1.05, SC 6.24±0.81). Ninetyone patients (48 in CM and 43 in SC) completed the 6-month functioning assessment. Repeated measures ANOVA shows a significant time*condition interaction effect in SOAFS, F(1,89)=8.31 (p=0.005) and in work productivity, F(1,89)=13.17 (p<0.001). Paired samples t-tests show that baseline scores of the CM group are significantly different from those at 6-month in both SOFAS, t(47)= -4.29, p<0.001, and work productivity, t(47)=-5.22, p<0.001. There is no significant change, however, in the SC group. Discussion: Early psychosis patients still show moderate difficulties in functioning after 2 years of specialised psychiatric and psychosocial treatment. The present study studies effects of an additional year of case management on patients’ functioning. Preliminary data suggest that, at 6-month outcome, significant changes in functioning, in particular work productivity, over time are due to improvements in the CM group, rather than deterioration in the SC group. Extension of service into the third year of treatment appears to be beneficial for patients. Further analyses with a larger sample entering the second and third time-points will provide a clearer picture of the benefits for extending case management service

Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention

BACKGROUND: Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP). METHOD: One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up. RESULTS: Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period. CONCLUSION: Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase