A randomised controlled trial of extended 1-year specialised case management for patients presenting with first-episode psychosis to early intervention Programme in Hong Kong

Abstract

BACKGROUND: Specialised early intervention (EI) service has been shown to be effective in improving short-term outcome of psychosis but such initial therapeutic benefits could not be maintained after service termination. Most EI services offer 2-year treatment and there is a paucity of data regarding effectiveness of longer-term EI service for psychosis. METHODS: This randomised single-blind controlled trial (RCT) [trial registered with ClinicalTrials.gov: NCT01202357] aimed to compare extended 1-year EI service (EI group, i.e. 3-year EI service, n = 82) comprising continuing phase-specific case management with step-down standard care service (SC group, i.e. 2-year EI service, n = 78) in 160 Chinese patients who had received 2-year intensive EI service for first-episode psychosis in Hong Kong. Participants were assessed at study entry, and 6 and 12 months of follow-up. Primary outcome was functioning. Outcome analyses were performed on intention-to-treat basis. RESULTS: No significant between-group differences in socio-demographics, discontinuation rate, treatment characteristics, and baseline clinical and functional measures were noted. By the end of 12-month follow-up, EI group had significantly better outcomes than SC group in global functioning and various specific functional dimensions including work productivity, independent living skills, and social relationship. Participants in EI group had significantly fewer negative and depressive symptoms, and lower outpatient default rate than those in SC group. Longitudinal analyses revealed differential trajectories of functioning between treatment groups with EI but not SC group showing sustained and progressive functional improvement over 12 months. CONCLUSION: This study is the first to provide empirical supportive evidence to extending specialised EI service for psychosis beyond 2 years using RCT design. Further follow-up is required to clarify the sustainability of treatment effects of this extended 1-year early intervention.