Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study

Revier, Camice J.; Reininghaus, Ulrich; Dutta, Rina; Fearon, Paul; Murray, Robin M.; Doody, Gillian A.; Croudace, Tim; Dazzan, Paola; Heslin, Margaret; Onyejiaka, Adanna; Kravariti, Eugenia; Lappin, Julia; Lomas, Ben; Kirkbride, James; Donoghue, Kim; Morgan, Craig; Jones, Peter B.

doi:10.1097/nmd.0000000000000295

Cited by 97 publications

(77 citation statements)

References 43 publications

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“…63 64 65 Our results differ from previous long term follow-up studies of SEI treatment where participants seem to relapse after end of the intervention treatment. But we did not find an effect of prolonged treatment on our primary outcome, and therefore the results of the main trial outcomes cannot serve as a basis for recommending SEI treatment for five years.…”

Section: Discussioncontrasting

confidence: 99%

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

Albert

Melau

Jensen

et al. 2017

BMJ

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Objective To compare the effects of five years of specialised early intervention (SEI) treatment for first episode schizophrenia spectrum disorder with the standard two years of SEI plus three years of treatment as usual.Design Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site.Setting Participants were recruited from six OPUS teams in Denmark between 2009 and 2012. OPUS teams provide SEI treatment to all patients diagnosed with a schizophrenia spectrum disorder in Denmark.Participants 400 participants (51% women) with a mean age of 25.6 (standard deviation 4.3) were randomised to five years of SEI (experimental intervention; n=197) or to two years of SEI plus three years of treatment as usual (control; n=203).Interventions OPUS treatment consists of three core elements—modified assertive community treatment, family involvement, and social skill training—with a patient-case manager ratio of no more than 12:1. For participants randomised to five years of OPUS treatment, the treatment was largely unchanged. Participants randomised to the control group were mostly referred to community health centres after two years of SEI treatment.Main outcomes Follow-up assessments were conducted five years after start of OPUS treatment. Primary outcome was negative symptoms measured on the scale for assessment of negative symptoms (avolition-apathy, anhedonia, alogia, and affective blunting). Secondary outcomes were remission of both negative and psychotic symptoms, psychotic symptoms, suicidal ideation, substance abuse, compliance with medical treatment, adherence with treatment, client satisfaction, days in hospital care, and labour market affiliation.Results Levels of negative symptoms did not differ between the intervention group and control group (1.72 v 1.81 points; estimated mean difference −0.10 (95% confidence interval 0.33 to 0.13), P=0.39). Participants receiving five years of OPUS treatment were more likely to remain in contact with specialised mental health services (90.4% v 55.6%, P<0.001), had higher client satisfaction (estimated mean difference 2.57 points (95% confidence interval 1.36 to 3.79), P<0.001), and had a stronger working alliance (estimated mean difference 5.56 points (95% confidence interval 2.30 to 8.82), P=0.001) than the control group.Conclusions This trial tests SEI treatment for up to five years for patients with first episode schizophrenia spectrum disorder; previous trials have found treatment effects for programmes lasting from one to three years. The prolonged SEI treatment had few effects, which could be due to the high level of treatment provided to control participants and the late start of specialised treatment.Trial registration Clinicaltrial.gov NCT00914238.

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Section: Discussioncontrasting

confidence: 99%

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

Albert

Melau

Jensen

et al. 2017

BMJ

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“…Nonetheless, it has been shown that it is possible to reliably quantify the course of disorder using routine data from clinical notes (Bebbington et al, 2006). Moreover, our thorough approach to data extraction from clinical notes has ensured that the rates of remission and time to first remission reported in this study are consistent with earlier studies which collected data from face-to-face interviews only (Revier et al, 2015), extracted it retrospectively from clinical notes (Ajnakina et al, 2017;Bromet et al, 2005;Harrison et al, 2001;Kohler et al, 2009) or employed both approaches (Morgan et al, 2014;Schoeler et al, 2017). Many diagnostic categories assigned to patients on first contact with mental health services may either be provisional or likely to change over the illness course (Schwartz et al, 2000), as seen in our sample with a relatively high number of patients with a diagnosis of schizophreniform disorder.…”

Section: Limitationssupporting

confidence: 78%

Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis

Ajnakina

Lally

Forti

et al. 2018

Schizophrenia Research

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There has been much recent debate concerning the relative clinical utility of symptom dimensions versus conventional diagnostic categories in patients with psychosis. We investigated whether symptom dimensions rated at presentation for first-episode psychosis Combining categorical diagnosis with symptom dimension scores in FEP patients improved the accuracy of predicting time to first remission. Thus our data suggest that the decision to consign symptom dimensions to an annexe in DSM-5 should be reconsidered at the earliest opportunity.

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“…A significant number of people with SMI can experience a reduction of both symptoms and associated impairments over time and make a full recovery. Research suggests that remission and recovery rates in first episode psychosis may be more favourable than previously thought, suggesting that a progressive deteriorating course of illness is not typical 3,4 . Indeed, for those who continue to live with the symptoms of psychosis, recovery in terms of personal, social and occupational aspirations is a realistic goal and sets the context for the recovery approach.…”

Section: What Is Severe Mental Illness?mentioning

confidence: 77%

Forward Thinking - NIHR research on support for people with severe mental illness

2018

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Ten-Year Outcomes of First-Episode Psychoses in the MRC ÆSOP-10 Study

Abstract: Supplemental digital content is available in the article.

Cited by 97 publications

References 43 publications

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II)

Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis

Forward Thinking - NIHR research on support for people with severe mental illness

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