Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

The primary aim was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis designed for implementation in the U.S. healthcare system, to Community Care on quality of life

Cardiometabolic Risk in Patients With First-Episode Schizophrenia Spectrum Disorders: Baseline Results From the RAISE-ETP Study

IMPORTANCE: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear. OBJECTIVE: To assess cardiometabolic risk in first-episode schizophrenia spectrum disorders (FES) and its relationship to illness duration, antipsychotic treatment duration and type, sex, and race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Baseline results of the Recovery After an Initial Schizophrenia Episode (RAISE) study, collected between July 22, 2010, and July 5, 2012, from 34 community mental health facilities without major research, teaching, or clinical FES programs. Patients were aged 15 to 40 years, had research-confirmed diagnoses of FES, and had less than 6 months of lifetime antipsychotic treatment. EXPOSURE: Prebaseline antipsychotic treatment was based on the community clinician's and/or patient's decision. MAIN OUTCOMES AND MEASURES: Body composition and fasting lipid, glucose, and insulin parameters. RESULTS: In 394 of 404 patients with cardiometabolic data (mean [SD] age, 23.6 [5.0] years; mean [SD] lifetime antipsychotic treatment, 47.3 [46.1] days), 48.3% were obese or overweight, 50.8% smoked, 56.5% had dyslipidemia, 39.9% had prehypertension, 10.0% had hypertension, and 13.2% had metabolic syndrome. Prediabetes (glucose based, 4.0%; hemoglobin A1c based, 15.4%) and diabetes (glucose based, 3.0%; hemoglobin A1c based, 2.9%) were less frequent. Total psychiatric illness duration correlated significantly with higher body mass index, fat mass, fat percentage, and waist circumference (all P<.01) but not elevated metabolic parameters (except triglycerides to HDL-C ratio [P=.04]). Conversely, antipsychotic treatment duration correlated significantly with higher non-HDL-C, triglycerides, and triglycerides to HDL-C ratio and lower HDL-C and systolic blood pressure (all P≤.01). In multivariable analyses, olanzapine was significantly associated with higher triglycerides, insulin, and insulin resistance, whereas quetiapine fumarate was associated with significantly higher triglycerides to HDL-C ratio (all P≤.02). CONCLUSIONS AND RELEVANCE: In patients with FES, cardiometabolic risk factors and abnormalities are present early in the illness and likely related to the underlying illness, unhealthy lifestyle, and antipsychotic medications, which interact with each other. Prevention of and early interventions for psychiatric illness and treatment with lower-risk agents, routine antipsychotic adverse effect monitoring, and smoking cessation interventions are needed from the earliest illness phases

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

Treatment guidelines suggest distinctive medication strategies for first episode and multi-episode patients with schizophrenia. How much community clinicians adjust their usual treatment regimens for first episode patients is unknown. We examined prescription patterns and factors associated with prescription choice within a national cohort of early phase patients

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

OBJECTIVE: Treatment guidelines suggest distinctive medication strategies for first episode and multi-episode patients with schizophrenia. How much community clinicians adjust their usual treatment regimens for first episode patients is unknown. We examined prescription patterns and factors associated with prescription choice within a national cohort of early phase patients. METHOD: Study entry prescription data (before any influence on treatment by study procedures) were obtained from 404 participants in the RAISE-ETP study, a US nationwide effectiveness study conducted at 34 community treatment centers in 21 states for patients with first episode schizophrenia-spectrum disorders. Subjects had been treated with antipsychotics for 6 months or less at study entry. RESULTS: We identified 159 subjects (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these 159 subjects, 8.8% were prescribed recommended antipsychotics at higher than recommended doses, 32.1% were prescribed olanzapine (often at high doses), 23.3% more than one antipsychotic, 36.5% an antipsychotic but also an antidepressant without a clear indication, 10.1% psychotropic medications without an antipsychotic and 1.2% stimulants. Multivariate analyses found evidence for sex, age and insurance status effects on medication prescription. Racial and ethnic effects consistent with effects found in prior multi-episode studies were found in univariate analyses. There were some regional variation in prescription practices; when present, regional patterns varied across prescribing practices. Diagnosis had limited, and inconsistent, effects. CONCLUSIONS: Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve first episode prescription practices. CLINICAL TRIALS REGISTRATION: NCT01321177: An Integrated Program for the Treatment of First Episode of Psychosis (RAISE ETP), http://www.clinicaltrials.gov/ct2/show/NCT0132117

Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

The primary aim was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis designed for implementation in the U.S. healthcare system, to Community Care on quality of life