Specialised care for early psychosis

Jan 10 2006

A new study has found that specialised care for early psychosis can achieve better outcomes than standard care.

Patients treated by an 'early onset' team were significantly better after 18 months in terms of social and vocational functioning, quality of life, satisfaction and adherence to medication.

The provision of early intervention services for people with psychosis is UK government policy, although until now evidence for its effectiveness has been sparse.

This study was one of the first UK randomised controlled trials to report the effects of an early intervention service. Published in the January 2006 issue of the British Journal of Psychiatry, it compared the outcomes of the work of the Lambeth Early Onset team, which provides specialised care for early psychosis, with existing services.

The Lambeth team was established in January 2000 on principles of assertive outreach, providing a single point of access for all the mental health and social welfare needs of its patients.

This multidisciplinary team included one team leader, one part-time consultant psychiatrist, one trainee psychiatrist, a half-time clinical psychologist, one occupational therapist, four community psychiatric nurses and two healthcare assistants.

It operated an extended hours service between 8am and 8pm five days a week, and between 9am and 5pm at weekends and on public holidays. The interventions provided were specially adapted for a group with early psychosis - a mix of medication management, cognitive behavioural therapy, vocational input and family interventions, according to individual need.

144 people with psychosis attending mental health services for the first or second time (if they previously failed to engage in treatment) were randomly allocated to care from the early onset team, or to standard care from a community mental health sector team.

Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Participants were studied at baseline and again 18 months later.

The results of the study indicated that the provision of a specialist service for people early in the course of psychosis has a range of benefits. At 18 months it had superior outcomes to standard care in:

• regaining or establishing social relationships
• time spent in vocational activity
• better overall ability to manage the tasks of everyday life
• levels of satisfaction with services
• a higher reported quality of life
• adherence to medication.

These are in addition to the previously reported benefits of increased contact with services, and reduction in hospitalisation.

Despite these benefits, it appears that the specialist early onset service does not specifically improve persisting symptoms, such as positive psychotic symptoms or depression.

The authors of the study conclude that a systematic approach to monitoring and preventing the early development of persisting psychotic symptoms should be taken.