Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial.,Schizophrenia bulletin

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Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial.
Schizophrenia bulletin Pub Date : 2022-09-01 , DOI: 10.1093/schbul/sbac053
Delbert G Robinson _{1,

2,

3} , Nina R Schooler ₄ , Patricia Marcy ₅ , Robert D Gibbons ₆ , C Hendricks Brown ₇ , Majnu John _{2,

8} , Kim T Mueser ₉ , David L Penn _{10,

11} , Robert A Rosenheck ₁₂ , Jean Addington ₁₃ , Mary F Brunette ₁₄ , Christoph U Correll _{1,

2,

3,

15} , Sue E Estroff ₁₆ , Piper S Mayer-Kalos ₁₇ , Jennifer D Gottlieb ₁₈ , Shirley M Glynn ₁₉ , David W Lynde ₁ , Susan Gingerich ₁ , Ronny Pipes ₂₀ , Alexander L Miller ₂₁ , Joanne B Severe ₁ , John M Kane _{1,

2,

3}

Affiliation

Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA.
Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Vanguard Research Group, Glen Oaks, NY, USA.
Center for Health Statistics, University of Chicago, Chicago, IL, USA.
Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Mathematics, Hofstra University, Hempstead, NY, USA.
Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
Department of Psychiatry, Yale Medical School, New Haven, CT,USA.
Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany.
Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Population Behavioral Health Innovation and Harvard Medical School, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Psychiatry and Behavioral Sciences San Antonio, UT Health San Antonio, TX, USA.

To examine long-term effects of early intervention services (EIS) for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223 participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15-40 years; DSM-IV diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic episode; antipsychotic medication taken for ≤6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants had assessments conducted ≥2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92,19.37) unit QLS and 7.73 (95%CI:2.98,12.47) unit PANSS better improvement and 2.53 (95%CI:0.59,4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated (P = .72) with QLS outcome; duration of untreated psychosis did not moderate (P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the data support long-term benefit of NAVIGATE compared to community care.

中文翻译：

首发精神病早期干预服务期间和之后的结果：RAISE-ETP 现场随机试验 5 年多的结果。

为了检查早期干预服务 (EIS) 对首发精神病的长期影响，我们将 Heinrichs-Carpenter 生活质量 (QLS) 和阳性和阴性综合征量表 (PANSS) 评分以及 5 年以上的住院天数与来自的数据进行了比较比较 EIS NAVIGATE（17 个站点；223 名参与者）和社区护理 (CC)（17 个站点；181 名参与者）的站点随机 RAISE-ETP 试验。入选标准为：年龄 15-40 岁；DSM-IV 对精神分裂症、分裂情感性障碍、精神分裂症样障碍、短暂精神病性障碍或未另行说明的精神病性障碍的诊断；第一次精神病发作；抗精神病药物服用时间≤6 个月。NAVIGATE 随机分配的参与者可以从他们的研究开始日期开始接受 NAVIGATE，直到 NAVIGATE 结束时最后一名入选的 NAVIGATE 参与者完成 2 年的治疗。每 6 个月进行一次评估。61% 的参与者进行了≥2 年的评估；5 年时为 31%。中位随访时间为 CC 30 个月和 NAVIGATE 38 个月。主要分析假设数据不是随机缺失的（NMAR）；敏感性分析假设数据是随机缺失的 (MAR)。MAR 分析发现 QLS 或 PANSS 没有显着的治疗时间相互作用。NMAR 分析显示 NAVIGATE 与 13.14 (95%CI:6.92,19.37) 单位的 QLS 和 7.73 (95%CI:2.98,12.47) 单位的 PANSS 改善相关，住院天数减少 2.53 (95%CI:0.59,4.47)比 CC（所有比较显着）。QLS 和 PANSS 效应大小分别为 0.856 和 0.70。NAVIGATE 机会长度（平均 33.8 (SD = 5.1) 个月）与 QLS 结果无关 (P = .72)；未经治疗的精神病持续时间并未缓和 (P = .32) 不同的 QLS 结果。虽然结论受到五年随访率低的限制，但数据支持 NAVIGATE 与社区护理相比的长期益处。

更新日期：2022-06-11

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