An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST)

Kuipers, Elizabeth; Holloway, Frank; Rabe‐Hesketh, Sophia; Tennakoon, Lakshika

doi:10.1007/s00127-004-0754-4

Cited by 92 publications

(77 citation statements)

References 15 publications

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“…We excluded 3 studies that were nonrandomized, 18,27,28 4 studies in which less than 75% of the sample were FEP patients, [29][30][31][32] 4 studies with a follow-up shorter than 6 months, [33][34][35][36] and 2 long-term RCTs that did not report on relapse/readmissions, and the authors confirmed that further data were not available. 37,38 Nine of the included studies investigated psychosocial interventions, and 9 examined pharmacological treatments.…”

Section: Resultsmentioning

confidence: 76%

Preventing the Second Episode: A Systematic Review and Meta-analysis of Psychosocial and Pharmacological Trials in First-Episode psychosis

Álvarez‐Jiménez

Parker

Hetrick

et al. 2009

Schizophrenia Bulletin

211

138

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Objective: The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. Methods: Systematic review and metaanalysis of RCTs. Results: Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR] 5 1.80, 95% confidence interval [CI] 5 1.31-2.48; P < .001; number needed to treat [NNT] 5 10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR 5 1.95, 95% CI 5 0.76-5.00; P 5 .17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR 5 4.88, 95% CI 5 0.97-24.60; P 5 .06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR 5 2.82, 95% CI 5 0.54-14.75; P 5 .22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with secondgeneration antipsychotics (SGAs) compared with FGAs (OR 5 1.47, 95% CI 5 1.07-2.01; P < .02; NNT 5 10). Conclusions: Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis.

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Section: Resultsmentioning

confidence: 76%

Preventing the Second Episode: A Systematic Review and Meta-analysis of Psychosocial and Pharmacological Trials in First-Episode psychosis

Álvarez‐Jiménez

Parker

Hetrick

et al. 2009

Schizophrenia Bulletin

211

138

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“…The idea of early intervention programs for schizophrenic patients includes not only early detection of disorders, but also multidisciplinary, com-prehensive care for patients and their families in the form of specialized pharmacological and non-pharmacological therapy: family interventions, behavioral cognitive therapy, social skills training, and problem solving, help with getting a job and extensive psycho-educational interventions for patients and their families. In 2010, Bird et al published a meta-analysis of several large controlled studies of early intervention in different centers around the world -COAST [93], LEO [94], OPUS [95], OTP [96], in which they demonstrated that during the first five years of illness, such early and widespread interventions have the advantage over standard care. Based on the results of this meta-analysis, early intervention in schizophrenic patients is believed to result in a clinically significant reduction in the risk of relapse and re-hospitalization.…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

“…W 2010 r. Bird i wsp. opublikowali wyniki metaanalizy kilku dużych kontrolowanych badań na temat wczesnych interwencji w różnych ośrodkach na świecie -badania: COAST [93], LEO [94], OPUS [95], OTP [96], w której wykazali, że w okresie pierwszych pięciu lat trwania choroby takie wczesne i szerokie interwencje mają przewagę nad opieką standardową. Na podstawie wyników tej metaanalizy uważa się, że wczesna, kompleksowa interwencja u osób chorych na schizofrenię skutkuje istotną klinicznie redukcją ryzyka nawrotu choroby i ponownych hospitalizacji.…”

Section: Implikacje Terapeutyczneunclassified

Review paper. Neuropsychological dimension of schizophrenia - evaluation possibilities and therapeutic implications

Makarewicz

Karakuła-Juchnowicz

Łobejko

2017

Current Problems of Psychiatry

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Introduction: In the last decades, researchers' attention has been focused on cognitive dysfunction in schizophrenia. Numerous studies indicate the existence of neurodegenerative deficits in schizophrenia including, but not limited to, motor functions, learning and memory, executive functions, attention, language, spatial skills and general intelligence.Method: A review of available literature on the topic of the past two decades, available in the Pubmed, EBSCO, SCOPUS databases has been made using the keywords: schizophrenia, cognition, early intervention.Results: Cognitive dysfunction is an important feature of the prodromal phase and the first episode of schizophrenia. Researchers have thus proposed to initiate early therapeutic interventions for people with so-called risky mental conditions. The article includes the reference to research on neurocognitive disorders essence in schizophrenia, the definition and review of methods used to identify specific cognitive deficits and issues related to risk of developing psychosis and early therapeutic intervention in high-risk states.Conclusions: Researchers report the importance of detecting cognitive disorders in the early stages of schizophrenia. This broadens the range of therapeutic interventions and enables early intervention in the increased risk of psychosis.

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“…En plus de contribuer à la diminution de symptômes négatifs, de symptômes psychotiques et de la toxicomanie, ils favorisent un engagement beaucoup plus marqué envers les services, une plus grande satisfaction des clients ainsi que des taux de suicide inférieurs à ceux des soins normaux (McGorry et coll., 2010 ;Nordentoft, Rasmussen, Melau, Hjorthoj et Thorup, 2014). Aucune différence significative n'a été constatée entre l'IP et les soins normaux dans un essai clinique randomisé dont la taille d'échantillon était très petite et dont les patients n'avaient peut-être pas commencé leur suivi dans un stade assez précoce (Kuipers, Holloway, Rabe-Hesketh et Tennakoon, 2004). Une méta-analyse a confirmé qu'une intervention intensive pendant les premiers stades de la psychose donnait des résultats cliniques (symptômes positifs et négatifs) et fonctionnels considérablement supérieurs à ceux des soins réguliers (Harvey, Lepage et Malla, 2007).…”

Section: éTudes Scientifiquesunclassified

Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures

Iyer

Malla

2014

smq

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Cet article fournit un survol de la logique de l’intervention précoce pour psychose, de ses fondements théoriques et de la littérature essentielle sur le concept. L’intervention précoce repose sur l’hypothèse de la période critique, qui vient accentuer l’importance des premiers stades de la maladie, et sur les résultats d’études dans le domaine, qui suggère que la durée d’une psychose non traitée en influence le pronostic. L’intervention précoce facilite l’accès à un traitement spécialisé adapté à la phase de la maladie par un processus de recommandations médicales plus ouvert, des délais rapides et l’éducation du public et des praticiens sur la psychose. L’intervention précoce, qui dure généralement deux ans à partir du dépistage, comprend une prise en charge intensive et des médicaments antipsychotiques à faible dose. L’accent est mis sur le fonctionnement social, l’intervention familiale, l’attention précoce aux troubles connexes ainsi qu’une alliance thérapeutique entre le jeune et sa famille. Selon les données scientifiques disponibles, une telle intervention donne de meilleurs résultats que les soins typiquement offerts. Les critiques du concept visent la qualité des études en sa faveur, sa mise en oeuvre, la répartition des ressources en intervention précoce et son utilité pour les personnes présentant un risque élevé de psychose. En termes de disponibilité et d’élaboration de politiques en intervention précoce, le Royaume-Uni détient une avance certaine, alors que le Canada se situe au milieu, et les États-Unis au bas de l’échelle. Au Québec, les résultats varient et d’autres études et investissements sont nécessaires. Récemment, le concept d’intervention précoce a servi d’exemple à des mesures plus importantes visant la transformation des soins de santé mentale des jeunes, ce qui constitue une toute nouvelle percée au Canada.Objectives: This paper seeks to provide an overview of the motives, rationale, theoretical underpinnings and foundational literature of the early intervention movement for psychoses. It also seeks to review the current status of the field, highlight its significant developments and identify its emergent trends.Methods: This paper begins by contextualizing the burden of psychosis. It then traces the origins of the early intervention movement and surveys the seminal literature that established and shapes the field. It describes the movement’s characteristic elements, types, approaches, strengths, criticisms and trajectories in select Western nations. It closes with a presentation of how the early intervention movement is informing broader endeavours to transform youth mental health.Results: We find that the early intervention movement is predicated on the critical period hypothesis that emphasizes the significance of the early stages of the illness; and on findings that the duration of untreated psychosis influences prognoses. Early intervention redresses this situation by facilitating access to specialized, phase-specific treatment. Access is enhanced through open referral, fast respo...

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An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST)

Cited by 92 publications

References 15 publications

Preventing the Second Episode: A Systematic Review and Meta-analysis of Psychosocial and Pharmacological Trials in First-Episode psychosis

Preventing the Second Episode: A Systematic Review and Meta-analysis of Psychosocial and Pharmacological Trials in First-Episode psychosis

Review paper. Neuropsychological dimension of schizophrenia - evaluation possibilities and therapeutic implications

Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures

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