Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression

The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal. To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis. Syste...

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Published in:	JAMA psychiatry (Chicago, Ill.) Vol. 75; no. 6; p. 555
Main Authors:	Correll, Christoph U, Galling, Britta, Pawar, Aditya, Krivko, Anastasia, Bonetto, Chiara, Ruggeri, Mirella, Craig, Thomas J, Nordentoft, Merete, Srihari, Vinod H, Guloksuz, Sinan, Hui, Christy L M, Chen, Eric Y H, Valencia, Marcelo, Juarez, Francisco, Robinson, Delbert G, Schooler, Nina R, Brunette, Mary F, Mueser, Kim T, Rosenheck, Robert A, Marcy, Patricia, Addington, Jean, Estroff, Sue E, Robinson, James, Penn, David, Severe, Joanne B, Kane, John M
Format:	Journal Article
Language:	English
Published:	United States 01-06-2018
Subjects:	Early Medical Intervention - methods Education - statistics & numerical data Employment - statistics & numerical data Hospitalization - statistics & numerical data Humans Psychotic Disorders - psychology Psychotic Disorders - therapy Randomized Controlled Trials as Topic Regression Analysis Schizophrenia - therapy Schizophrenic Psychology Severity of Illness Index
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Summary:	The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal. To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis. Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017. Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders. This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses. The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period. Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months). In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
ISSN:	2168-6238
DOI:	10.1001/jamapsychiatry.2018.0623