Do early intervention services impact long-term outcomes in patients with psychosis?

Early intervention services (EIS) specifically designed to meet the needs of patients with early-phase psychosis (EPS) and first-episode psychosis (FEP) have been an important part of mental health treatment over the past two decades. Professor Eric Chen, University of Hong Kong, Hong Kong summarised some of the research into the effect of EIS on outcomes in patients with psychosis at SIRS 2022.

Early intervention services (EIS) involve multidisciplinary teams that provide psychopharmacological and psychosocial interventions tailored to the needs of individual patients.

EIS significantly improve outcomes for patients with first-episode psychosis

In a meta-analysis of 10 randomised, controlled trials including more than 2000 patients with first-episode or early schizophrenia spectrum psychosis, EIS (duration 6─24 months) was associated with significantly improved outcomes during the treatment period for positive and negative symptoms, involvement in school or work, hospitalization, and treatment discontinuation, compared with treatment as usual.1

EIS significantly improve outcomes for patients with first-episode psychosis

 

Can short-term EIS impact long term outcomes?

Studies with 10-year follow-up from 2 years of EIS in Hong Kong showed that EIS leads to reduced risk of suicide, longer periods of employment, fewer and shorter duration of hospitalizations, and reduced risk of suicide, compared to standard care.2,3

In a recent randomised controlled trial in 360 patients with psychosis with a mean age of 38 years, randomised to EIS or standard care for either 2 or 4 years, patients treated with EIS for 4 years had significantly better functioning on the role functioning scale (RFS; interaction estimate=0.008, P=0.02) and significantly better extended social network (interaction estimate=0.011, P=0.003) compared with standard care. These improvements were specifically observed in the first 2 years, with the authors suggesting that treatment for up to 4 years provides little benefit over 2 years.4 Interestingly, 4 years of EIS had a greater impact on the RFS for patients with a long duration of untreated psychosis (DUP) compared to those with a shorter DUP, noted Professor Chen.4

Patients with longer duration of psychosis (DUP) may be more responsive to longer EIS than those with shorter DUP

 

Biological and clinical critical periods may affect EIS outcome

The ‘critical period’ is an established biological concept for a time in which the brain has particular neuroplasticity, and is more easily influenced by environmental conditions. In schizophrenia, the critical period is clinical and is considered as the first 2 to 5 years of early psychosis, when deterioration occurs more aggressively. EIS starting from FEP can increase the likelihood of reduced or delayed neuroplastic changes that lead to chronic symptoms.5,6

EIS for first-episode psychosis may reduce or delay neuroplastic changes that lead to chronic symptoms

Factors that occur during the critical period can affect the outcome of EIS, but it is not ‘all or nothing’, said Professor Chen. There are factors that influence the critical period and others that do not, and there may also be overlap between biological and clinical critical periods. Modifiable factors that may influence the critical period include substance abuse, EIS duration and content, community acceptance of psychosis, social support networks, and patient choice.

Identifying factors for individual patients could affect EIS choice and improve outcomes.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Correll CU, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2018;75:555─565.
  2. Chan SK, et al. Early intervention versus standard care for psychosis in Hong Kong: a 10-year study. Hong Kong Med J 2015;21 Suppl 2:19─22. 
  3. Chan SK, et al. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med 2015;45:1181─93.
  4. Hui CLM, et al. Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial. Psychol Med 2022:1─13.
  5. Coentre R, et al. Early intervention in psychosis: first-episode psychosis and critical period. Acta Med Port 2011;24:117─26. 
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