Intensive Early Psychosis Intervention Doesn't Go the Distance

Although previous studies show intensive early intervention to be effective in reducing psychotic symptoms in patients with first-episode psychosis, the benefits aren’t sustainable, even at just five years, returning “to baseline levels after patients finished the two-year course and were subsequently referred for treatment according to their needs,” according to results of the OPUS trial published in the July issue of Archives of General Psychiatry.

In the study, patients were randomized to intensive early-intervention treatment—consisting of assertive community treatment, family involvement, and social skills training—or standard treatment—consisting of contact with a community mental health center—to compare psychotic, disorganized dimension, and negative symptoms (primary outcomes), as well as use of services and social functioning (secondary outcomes).

At two-years follow-up, patients in the early-intervention group displayed significant improvements in the primary outcomes, as well as in secondary substance abuse, treatment adherence, success with lower dosages of antipsychotic medications, and higher satisfaction with treatment compared with patients in the standard treatment group. But the differences weren’t seen in primary outcomes at five years.

“This trial pinpoints the intrinsic problem of early-intervention services, namely 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,” wrote the authors.

However, differences were seen at five years in favor of the intervention group in regards to the secondary outcome measures that looked at patients who live in supported housing and days in hospital.

What’s the impact?

Will the results of this study impact the therapies you prescribe to your patients with psychosis? If so, how? Are the added expenses and time that come with intensive intervention worth the benefits in secondary outcomes alone? What about those two years of increased benefit over standard therapy? Are there other options that show benefits in the long run, or are patients with psychosis destined to a long-term bout with delusion, hallucinations, personality changes, and disorganized thinking? What results have you seen in patients treated for psychosis?