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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-2400 Copenhagen NV, Denmark
J. Øhlenschlæger
Affiliation:
Psychiatric Centre Sct. Hans, 4000 Roskilde, Denmark
A. Thorup
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
L. Petersen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
Pia Jeppesen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
M. Bertelsen
Affiliation:
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
*
*Address for correspondence: Dr M. Nordentoft, Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, 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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References

Anderson, CM, Reiss, DJ, Hogarty, GE (1986). Schizophrenia in the Family. A Practitioner's Guide to Psychoeducation and Management. Guilford Press: New York.Google Scholar
Andreasen, NC, Arndt, S, Alliger, R, Miller, D, Flaum, M (1995). Symptoms of schizophrenia. Methods, meanings, and mechanisms. Archives of General Psychiatry 52, 341–351.CrossRefGoogle ScholarPubMed
Arndt, S, Andreasen, NC, Flaum, M, Miller, D, Nopoulos, P (1995). A longitudinal study of symptom dimensions in schizophrenia. Prediction and patterns of change. Archives of General Psychiatry 52, 352–360.CrossRefGoogle ScholarPubMed
Cullberg, J, Levander, S, Holmqvist, R, Mattsson, M, Wieselgren, IM (2002). One-year outcome in first episode psychosis patients in the Swedish Parachute project. Acta Psychiatrica Scandinavica 106, 276–285.CrossRefGoogle ScholarPubMed
Danish Psychiatric Association (1998). www.dpsnet.dk/fileadmin/web-filer/PDF/Rapporter/039_klaringsrapport_antipsykotika.pdf.Google Scholar
Hauff, E, Varvin, S, Laake, P, Melle, I, Vaglum, P, Friis, S (2002). Inpatient psychotherapy compared with usual care for patients who have schizophrenic psychoses. Psychiatric Services 53, 471–473.CrossRefGoogle ScholarPubMed
Lamb, HR, Shaner, R (1993). When there are almost no state hospital beds left. [Review]. Hospital and Community. Psychiatry 44, 973–976.Google Scholar
Liberman, RP, Mueser, KT, Wallace, CJ, Jacobs, HE, Eckman, T, Massel, HK (1986). Training skills in the psychiatrically disabled: learning coping and competence. Schizophrenia Bulletin 12, 631–647.CrossRefGoogle ScholarPubMed
Malmberg, L, Fenton, M (2001). Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness. Cochrane Database of Systematic Reviews. Art No. CD001360. Issue 3. doi: 10.1002/14651858.CrossRefGoogle ScholarPubMed
Marshall, M, Lockwood, A (2003). Assertive Community Treatment for people with severe mental disorders. Cochrane Library 5.Google Scholar
McFarlane, WR (1995). Multiple-family groups and psychoeducation in the treatment of schizophrenia. Archives of General Psychiatry 52, 679–687.CrossRefGoogle ScholarPubMed
McFarlane, WR (2002). Multifamily Groups in the Treatment of Severe Psychiatric Disorders. Guilford Press: New York/London.Google Scholar
McGorry, PD, Edwards, J, Mihalopoulos, C, Harringan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305–326.CrossRefGoogle ScholarPubMed
McGrew, JH, Bond, GR, Dietzen, L, Salyers, M (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology 62, 670–678.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P, Mortensen, PB (1997). The Danish Psychiatric Central Register. Danish Medical Bulletin 44, 82–84.Google ScholarPubMed
Ohlenschlaeger, J, Thorup, A, Petersen, L, Jeppesen, P, Koster, A, Munkner, R, Nordentoft, M (2007). Intensive treatment models and coercion. Nordic Journal of Psychiatry 61, 369–378.CrossRefGoogle ScholarPubMed
Pedersen, CB, Gotzsche, H, Moller, JO, Mortensen, PB (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin 53, 441–449.Google ScholarPubMed
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.CrossRefGoogle ScholarPubMed
Stein, LI, Test, MA (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 37, 392–397.CrossRefGoogle ScholarPubMed
WHO (1993). ICD-10 Classification of Mental Health and Behavioral Disorders. Diagnostic Criteria for Research, 1st edn. WHO: Geneva.Google Scholar
Wing, JK, Brown, GW (1970). Institutionalism and Schizophrenia. Cambridge University Press: Cambridge.CrossRefGoogle Scholar