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Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial

Published online by Cambridge University Press:  11 February 2022

Christy Lai Ming Hui
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Andreas Kar Hin Wong
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Elise Chun Ning Ho
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Bertha Sze Ting Lam
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Priscilla Wing Man Hui
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Tiffany Junchen Tao
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Wing Chung Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
Sherry Kit Wa Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
Edwin Ho Ming Lee
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Yi Nam Suen
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
May Mei Ling Lam
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Cindy Pui Yu Chiu
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
Frendi Wing Sai Li
Affiliation:
Department of Psychology, University of Hong Kong, Pok Fu Lam, Hong Kong
Kwok Fai Leung
Affiliation:
Department of Occupational Therapy, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
Sarah M. McGhee
Affiliation:
School of Public Health, University of Hong Kong, Pok Fu Lam, Hong Kong
Chi Wing Law
Affiliation:
Department of Psychiatry, Queen Mary Hospital, Pok Fu Lam, Hong Kong
Dicky Wai Sau Chung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Tai Po, Hong Kong
Wai Song Yeung
Affiliation:
Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
Michael Gar Chung Yiu
Affiliation:
Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
Edwin Pui Fai Pang
Affiliation:
Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
Steve Tso
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
Simon Sai Yu Lui
Affiliation:
Department of Psychiatry, Castle Peak Hospital, Tuen Mun, Hong Kong
Se Fong Hung
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
Wing King Lee
Affiliation:
Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong
Ka Chee Yip
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Ka Lik Kwan
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Roger Man Kin Ng
Affiliation:
Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong
Pak Chung Sham
Affiliation:
State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong Department of Psychiatry, King's College London, London, UK
William G. Honer
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, Canada
Eric Yu Hai Chen*
Affiliation:
Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
*
Author for correspondence: Eric Yu Hai Chen, E-mail: ericchen.hku@gmail.com

Abstract

Background

Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.

Methods

360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.

Results

Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.

Conclusions

Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.

Type
Original Article
Copyright
Copyright © University of Hong Kong, 2022. Published by Cambridge University Press

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