Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial

Delbert G Robinson^{1

2

3}, Nina R Schooler⁴, Patricia Marcy⁵, Robert D Gibbons⁶, C Hendricks Brown⁷, Majnu John^{2

8}, Kim T Mueser⁹, David L Penn^{10

11}, Robert A Rosenheck¹², Jean Addington¹³, Mary F Brunette¹⁴, Christoph U Correll^{1

2

3

15}, Sue E Estroff¹⁶, Piper S Mayer-Kalos¹⁷, Jennifer D Gottlieb¹⁸, Shirley M Glynn¹⁹, David W Lynde¹, Susan Gingerich¹, Ronny Pipes²⁰, Alexander L Miller²¹, Joanne B Severe¹, John M Kane^{1

2

3}

Affiliations

¹ Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
² The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
³ The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA.
⁴ Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA.
⁵ Vanguard Research Group, Glen Oaks, NY, USA.
⁶ Center for Health Statistics, University of Chicago, Chicago, IL, USA.
⁷ Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁸ Department of Mathematics, Hofstra University, Hempstead, NY, USA.
⁹ Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
¹⁰ Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹¹ School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
¹² Department of Psychiatry, Yale Medical School, New Haven, CT,USA.
¹³ Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
¹⁴ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁵ Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany.
¹⁶ Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹⁷ Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁸ Division of Population Behavioral Health Innovation and Harvard Medical School, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
¹⁹ Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
²⁰ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
²¹ Department of Psychiatry and Behavioral Sciences San Antonio, UT Health San Antonio, TX, USA.

PMID: 35689478
PMCID: PMC9434430
DOI: 10.1093/schbul/sbac053

Randomized Controlled Trial

Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial

Delbert G Robinson et al. Schizophr Bull. 2022.

. 2022 Sep 1;48(5):1021-1031.

doi: 10.1093/schbul/sbac053.

Authors

Affiliations

¹ Departments of Psychiatry and of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
² The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Manhasset, NY, USA.
³ The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA.
⁴ Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA.
⁵ Vanguard Research Group, Glen Oaks, NY, USA.
⁶ Center for Health Statistics, University of Chicago, Chicago, IL, USA.
⁷ Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁸ Department of Mathematics, Hofstra University, Hempstead, NY, USA.
⁹ Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
¹⁰ Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹¹ School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
¹² Department of Psychiatry, Yale Medical School, New Haven, CT,USA.
¹³ Department of Psychiatry, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
¹⁴ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁵ Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin, Berlin, Germany.
¹⁶ Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹⁷ Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁸ Division of Population Behavioral Health Innovation and Harvard Medical School, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
¹⁹ Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
²⁰ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
²¹ Department of Psychiatry and Behavioral Sciences San Antonio, UT Health San Antonio, TX, USA.

PMID: 35689478
PMCID: PMC9434430
DOI: 10.1093/schbul/sbac053

Abstract

To examine long-term effects of early intervention services (EIS) for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223 participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15-40 years; DSM-IV diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic episode; antipsychotic medication taken for ≤6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants had assessments conducted ≥2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92,19.37) unit QLS and 7.73 (95%CI:2.98,12.47) unit PANSS better improvement and 2.53 (95%CI:0.59,4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated (P = .72) with QLS outcome; duration of untreated psychosis did not moderate (P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the data support long-term benefit of NAVIGATE compared to community care.

Keywords: coordinated specialty care; early intervention services; first episode psychosis; follow-up; schizophrenia.

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Figures

**Fig. 2.**
Shared parameter model of Heinrichs Carpenter Quality of Life Scale (QLS) total scores and Positive and Negative Syndrome Scale (PANSS) total scores.Dark line = Community Care estimated from model; Red line = NAVIGATE estimated from model.

See this image and copyright information in PMC

References

1. NIMH. Evidence-based treatments for first episode psychosis: components of coordinated specialty care. https://www.nimh.nih.gov/health/topics/schizophrenia/raise/evidence-base.... Accessed June 4, 2019.
1. Correll CU, Galling B, Pawar A, 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(6):555–565. - PMC - PubMed
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Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial

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Outcomes During and After Early Intervention Services for First-Episode Psychosis: Results Over 5 Years From the RAISE-ETP Site-Randomized Trial

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