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Randomized Controlled Trial
. 2016 Apr 1;173(4):362-72.
doi: 10.1176/appi.ajp.2015.15050632. Epub 2015 Oct 20.

Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

John M Kane  1 , Delbert G Robinson  1 , Nina R Schooler  1 , Kim T Mueser  1 , David L Penn  1 , Robert A Rosenheck  1 , Jean Addington  1 , Mary F Brunette  1 , Christoph U Correll  1 , Sue E Estroff  1 , Patricia Marcy  1 , James Robinson  1 , Piper S Meyer-Kalos  1 , Jennifer D Gottlieb  1 , Shirley M Glynn  1 , David W Lynde  1 , Ronny Pipes  1 , Benji T Kurian  1 , Alexander L Miller  1 , Susan T Azrin  1 , Amy B Goldstein  1 , Joanne B Severe  1 , Haiqun Lin  1 , Kyaw J Sint  1 , Majnu John  1 , Robert K Heinssen  1
Affiliations
Randomized Controlled Trial

Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

John M Kane et al. Am J Psychiatry. .

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01321177.

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Figures

Figure 1
Figure 1
Patient self-report of use of NAVIGATE model targeted services during study period at NAVIGATE and Community Care Sites
Figure 2
Figure 2
Model-Based Estimates of Heinrichs-Carpenter Quality of Life (QLS) Total Score and PANSS Total Score.
Figure 3
Figure 3
Heinrichs-Carpenter Quality of Life (QLS) Total Score and PANSS Total Score: Effects of Shorter vs. Longer Duration of Untreated Psychosis (DUP) based on a model with square root transformation of months1.
See this image and copyright information in PMC

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References

    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global Burden of Disease and Risk Factors. World Bank; Washington, DC: 2006. - PubMed
    1. Jaaskelainen E, Juola R, Hirvonen N, McGrath JJ, Saha S, Isohanni M, Veijola J, Miettunen J. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013;39(6):1296–306. - PMC - PubMed
    1. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavior therapy and family intervention in early psychosis: systematic review. British Journal of Psychiatry. 2010;197(5):350–356. - PMC - PubMed
    1. Alvarez-Jimenez M, Parker AG, Hetrick SE, McGorry PD, Gleeson JF. Preventing the second episode: A systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophrenia Bulletin. 2011;37(3):619–630. - PMC - PubMed
    1. Addington J. The promise of early intervention. Early Intervention in Psychiatry. 2007;1(4):294–307. - PubMed

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