Effects of extended case management on functioning in people with early psychosis- Preliminary findings of the easy3 randomised controlled study

Abstract

Background: The Early Assessment Service for Young People with psychosis (EASY) in Hong Kong provides case management to first-episode psychosis patients for the first 2 years of treatment. However, clinically, the first few years of illness are still eventful, and theoretically, within the critical period that determines long-term outcomes. This study aims at investigating the optimal duration of early intervention for patients with early psychosis. Methods: One hundred and sixty EASY patients who had received 2 years of case management were stratified and randomised to receiving either an additional year (in total 3 years) of case management (CM) or standard care (SC). Symptom and functioning outcomes are compared at 6 months and 1 year after recruitment. Results: At this stage, 2 patients dropped out from the study (1 was transferred to another clinic and 1 requested to withdraw from the study during a relapse of psychotic symptoms). At baseline, there is no significant difference between the CM (n=80) and SC (n=78) groups in age (CM 23.00±3.08, SC 22.74±3.32years), gender, education, and duration of untreated psychosis (CM 60.00; IQR 17.50 to 314.50days, SC 90.00; IQR 14.00 to 333.00days). The two groups did not differ in terms of symptoms and social and occupational functioning (SOFAS, out of 100) and role functioning (out of 7) at baseline. Patients showed moderate difficulty (CM 57.66±14.28, SC 57.99±13.69) in general social and occupational functioning, marginal functioning in work productivity (CM 4.11±1.79, SC 4.60±1.52) and extended social relationships (CM 4.16±1.40, SC 3.99±1.49), and moderate functioning in independent living (CM 6.05±1.05, SC 6.24±0.81). Ninetyone patients (48 in CM and 43 in SC) completed the 6-month functioning assessment. Repeated measures ANOVA shows a significant time*condition interaction effect in SOAFS, F(1,89)=8.31 (p=0.005) and in work productivity, F(1,89)=13.17 (p<0.001). Paired samples t-tests show that baseline scores of the CM group are significantly different from those at 6-month in both SOFAS, t(47)= -4.29, p<0.001, and work productivity, t(47)=-5.22, p<0.001. There is no significant change, however, in the SC group. Discussion: Early psychosis patients still show moderate difficulties in functioning after 2 years of specialised psychiatric and psychosocial treatment. The present study studies effects of an additional year of case management on patients’ functioning. Preliminary data suggest that, at 6-month outcome, significant changes in functioning, in particular work productivity, over time are due to improvements in the CM group, rather than deterioration in the SC group. Extension of service into the third year of treatment appears to be beneficial for patients. Further analyses with a larger sample entering the second and third time-points will provide a clearer picture of the benefits for extending case management service.