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Keywords:

  • community mental health service;
  • early diagnosis;
  • follow-up study;
  • programme evaluation;
  • psychotic disorder

Abstract

Aim: Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis.

Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records.

Results: Patients in the early intervention group had longer full-time employment or study (P < 0.001), fewer days of hospitalization (P < 0.001), less severe positive symptoms (P = 0.006), less severe negative symptoms (P = 0.001), fewer suicides (P = 0.009) and fewer disengagements (P = 0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P = 0.001), but the two groups had similar rates of relapse (P = 0.08) and durations of untreated psychosis (P = 0.72).

Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse.