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Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

Published online by Cambridge University Press:  11 January 2010

M. Nordentoft ,
J. Øhlenschlæger ,
A. Thorup ,
L. Petersen ,
Pia Jeppesen  and
M. Bertelsen
M. Nordentoft*
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark
J. Øhlenschlæger
Affiliation:
Psychiatric Centre Sct. Hans, 4000Roskilde, Denmark
A. Thorup
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark
L. Petersen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark
Pia Jeppesen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark
M. Bertelsen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark
*
*Address for correspondence: Dr M. Nordentoft, Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400CopenhagenNV, Denmark. (Email: mn@dadlnet.dk)
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Abstract

Background

The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.

Method

A total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.

Results

It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.

Conclusions

The study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

Keywords

Cohort studyfirst-episode schizophrenia spectrum disorderintensive interventionsupported housinguse of bed days
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 10 , October 2010 , pp. 1619 - 1626
Copyright
Copyright © Cambridge University Press 2010

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