This study aimed to determine whether, following two years of specialized support for first‐episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single‐blind randomized controlled trial. Participants were people with first‐episode psychosis (N=170), aged 16‐27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer‐to‐peer social networking; theory‐driven and evidence‐informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty‐seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18‐month follow‐up, with no evidence of significant between‐group differences (PSP mean difference: –0.29, 95% CI: –4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09‐28.23, p=0.04), with evidence of a dose‐response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11‐0.86, p=0.03, number needed to treat, NNT=5). There was a non‐significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11‐1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first‐episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first‐episode psychosis beyond specialist services.

中文翻译：

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Horyzons项目：一项新颖的在线社会疗法的随机对照试验，以维持专业的第一期精神病服务的治疗效果

这项研究旨在确定，在为首发精神病患者提供了两年的专业支持之后，在常规治疗（TAU）中添加18个月的新数字干预（Horyzons）是否比单独使用TAU的18个月更有效。我们进行了单盲随机对照试验。参加者为年龄在16-27岁之间的初发精神病患者（N = 170），他们的临床症状缓解，并且即将通过专门服务出院。在2013年10月至2017年1月之间，他们被随机分配（1：1）以接受Horyzons加TAU（N = 86）或仅接受TAU（N = 84）。Horyzons是一种新颖的，全面的数字平台合并：对等社交联网; 针对社会功能，职业恢复和预防复发的理论驱动和循证医学治疗干预；专业的临床医生和职业支持；以及同伴的支持和节制。TAU涉及向初级或三级社区心理健康服务的转移。主要结果是通过个人和社会绩效量表（PSP）衡量的18个月时的社会功能。Horyzons + TAU组的47位参与者（55.5％）登录了至少6个月，而40位参与者（47.0％）登录了至少9个月。从基线到随访18个月，两组的社交功能均保持较高水平且稳定，没有证据表明组间存在显着差异（PSP平均差异：–0.29，95％CI：–4.20至3.63，p = 0.77）。与TAU相比，Horyzons组的参与者找到工作或入学的几率增加了5.5倍（优势比，OR = 5.55，95％CI：1.09-28.23，p = 0.04），有剂量反应作用的证据。此外，与Horyzons组相比，TAU参与者访问急诊服务的可能性是其两倍（39％比19％; OR = 0.31，95％CI：0.11-0.86，p = 0.03，需要治疗的人数，NNT = 5）。Horyzons组与TAU相比，因精神病导致的住院率下降趋势不显着（13％vs. 27％； OR = 0.36，95％CI：0.11-1.08，p = 0.07，NNT = 7）。因此，尽管与TAU相比，我们并未发现霍里松对社会功能有显着影响，但该干预措施有效地提高了职业或教育水平，这是社会恢复的核心组成部分，并减少了医院急诊服务的使用，这是该项目的主要目标。专业的首发精神病服务。