May 16, 2018 / 9:29 PM / 7 months ago

Schizophrenics may do better with earlier, team-based care

(Reuters Health) - People with schizophrenia who are treated early in their disease course, with extra support in addition to drugs and psychotherapy, may do better than they would with usual treatment, which often lacks coordination and starts after psychosis has taken hold, a recent study suggests.

Researchers examined data from 10 previous trials involving a total of 2,176 patients with schizophrenia. All of the experiments randomly assigned some patients to receive usual treatment and others to get earlier intervention with more comprehensive services.

With early intervention, patients had greater improvement in the severity of psychotic symptoms than with treatment as usual, the study found. Early-intervention patients were also less likely to discontinue treatment or need inpatient psychiatric care.

“Early integrated services go beyond the building block of medication management and integrate into the treatment plan elements, such as psychoeducation of patients and their families, individual psychotherapy, family therapy, vocational and educational counseling, case management and crisis response and management,” said lead study author Dr. Christoph Correll, a psychiatry researcher at Zucker Hillside Hospital in Glen Oaks, New York.

“Usual or community care provides much fewer of these important treatment elements, there is no special training or specific expertise in how to best manage people with early-phase psychosis, and there is no integrated team approach that coordinates the care according to the individual patients’ and their families’ needs,” Correll said by email.

Schizophrenia is a leading cause of disability in the U.S. and treatment outcomes are often suboptimal, with patients often halting treatment too soon or failing to receive enough help to recover from psychotic episodes, the researchers noted in JAMA Psychiatry.

The condition often surfaces in adolescence and young adulthood, critical periods for learning how to succeed in school, work and relationships. People with schizophrenia can suffer from a variety of symptoms that can interfere with every aspect of their lives, including delusions, hallucinations and difficulties with concentration and motivation.

Most patients with schizophrenia aren’t violent, but people with this chronic brain disorder often experience psychotic episodes when they lose touch with reality.

Each of the experiments included in the current analysis focused on patients going through their first psychotic episode or experiencing the early stages of delusion or other disabling schizophrenia symptoms. These trials lasted an average of 16 months and included patients who were typically in their late 20s.

Treatment in the early-intervention programs was typically twice as intensive as usual care provided in these experiments.

Across all of the experiments, about 21 percent of patients in early-intervention programs discontinued treatment early, compared to 31 percent with usual care. Treatment discontinuation often happens when symptoms aren’t properly controlled.

About 32 percent of the early-intervention patients had at least one psychiatric hospitalization, compared with 42 percent of people receiving usual care.

One limitation of the study is that the wide variety of designs in the smaller experiments in the analysis made it difficult to compare results across all the studies, the authors note. The trials were also too brief to assess any long-term effects of early intervention programs on patients with schizophrenia.

Even so, the results offer fresh evidence of the potential for early-intervention programs to provide a more comprehensive and more effective approach to care, said Dr. Patrick McGorry of the Centre for Youth Mental Health at the University of Melbourne in Australia.

“They receive proactive care which smoothes engagement with health care and avoids life-threatening crises and they are presented with an optimistic and positive view of their prognosis and capacity to recover,” McGorry, who co-authored an accompanying editorial, said by email.

“Medications are used very carefully and in the lowest effective dose and holistic care is offered which includes attention to physical health, substance use, family support, vocational and employment expertise and also developmental and personal needs,” McGorry added. “Patients and families are much more satisfied and engage much better.”

SOURCE: bit.ly/2GpzMQP and bit.ly/2wJAgSk JAMA Psychiatry, online May 2, 2018.

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