Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial. (11th June 2022)

• Record Type: Journal Article
• Authors: Robinson, Delbert G; Schooler, Nina R; Marcy, Patricia; Gibbons, Robert D; Hendricks Brown, C; John, Majnu; Mueser, Kim T; Penn, David L; Rosenheck, Robert A; Addington, Jean; Brunette, Mary F; Correll, Christoph U; Estroff, Sue E; Mayer-Kalos, Piper S; Gottlieb, Jennifer D; Glynn, Shirley M; Lynde, David W; Gingerich, Susan; Pipes, Ronny; Miller, Alexander L; Severe, Joanne B; Kane, John M
• Is Part Of: Schizophrenia bulletin. Volume 48:Number 5(2022)
• Page Start: 1021
• Page End: 1031
• Publication Date: 2022-06-11
• Subjects: coordinated specialty care -- schizophrenia -- follow-up -- early intervention services -- first episode psychosis; Schizophrenia -- Periodicals; Schizophrenia -- Research -- Periodicals; 616.898005
• DOI: 10.1093/schbul/sbac053
• Languages: English
• ISSNs: 0586-7614

Abstract

Abstract: To examine long-term effects of early intervention services (EIS) for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223 participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15–40 years; DSM-IV diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic episode; antipsychotic medication taken for ≤6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants had assessments conducted ≥2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92, 19.37) unit QLS and 7.73 (95%CI:2.98, 12.47) unit PANSS better improvement and 2.53 (95%CI:0.59, 4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated ( P = .72) with QLS outcome; duration of untreated psychosis did not moderate ( P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the data support long-term benefit of NAVIGATE compared to community care.