Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program
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Résumé
OBJECTIVE: The primary aim of this study was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first-episode psychosis designed for implementation in the U.S. health care system, with community care on quality of life. METHOD: Thirty-four clinics in 21 states were randomly assigned to NAVIGATE or community care. Diagnosis, duration of untreated psychosis, and clinical outcomes were assessed via live, two-way video by remote, centralized raters masked to study design and treatment. Participants (mean age, 23) with schizophrenia and related disorders and ≤6 months of antipsychotic treatment (N=404) were enrolled and followed for ≥2 years. The primary outcome was the total score of the Heinrichs-Carpenter Quality of Life Scale, a measure that includes sense of purpose, motivation, emotional and social interactions, role functioning, and engagement in regular activities. RESULTS: The 223 recipients of NAVIGATE remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school compared with 181 participants in community care. The median duration of untreated psychosis was 74 weeks. NAVIGATE participants with duration of untreated psychosis of <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. Rates of hospitalization were relatively low compared with other first-episode psychosis clinical trials and did not differ between groups. CONCLUSIONS: Comprehensive care for first-episode psychosis can be implemented in U.S. community clinics and improves functional and clinical outcomes. Effects are more pronounced for those with shorter duration of untreated psychosis.
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La notice
- Revue
- American Journal of Psychiatry
- Thématique
- Schizophrenia research and treatment
- Domaine
- Medicine
- Établissements canadiens
- —
- Organismes subventionnaires
- National Institute of Mental HealthJane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los AngelesSUNY Downstate Medical CenterUniversity of Texas Health Science Center at San AntonioUniversity of North Carolina at Chapel HillState University of New YorkEli Lilly and CompanyAustralian Catholic UniversityU.S. Public Health ServiceGenentechSunovionH. Lundbeck A/SNational Center for Advancing Translational SciencesTeva Pharmaceutical IndustriesLes Laboratories Pierre FabreUniversity of Missouri-Kansas CityDartmouth CollegeHotchkiss Brain Institute, University of CalgaryBristol-Myers SquibbUniversity of MinnesotaPfizerUniversity of MissouriNovo NordiskAmgenYale Liver CenterYale UniversityU.S. Department of Health and Human Services
- Mots-clés
- PsychosisEarly psychosisPsychiatryPsychologyMedicineClinical psychology
- Résumé présent dans OpenAlex
- oui