Early Intervention Services for Schizophrenia Had No Lasting Effects at 20 Years

Researchers working on a long-term follow-up study found no difference at 20 years among patients with schizophrenia spectrum disorders who received 2 years of early intervention services (EIS) or treatment as usual (TAU). These findings were published in JAMA Psychiatry.

Patients (N=547) with schizophrenia spectrum disorders were recruited in Aarhus and Copenhagen in Denmark between 1998 and 2000 for the Danish OPUS trial. The patients received either EIS or TAU for 2 years. The EIS comprised social skill training, psychoeducation, and family involvement and the ratio between staff and patient was 1:10, whereas TAU was standard treatment with staff: patient ratios ranging between 1:20 and 1:30.

In this study, the changes in Scale for Assessment for Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), and Global Assessment of Functioning scale (GAF-F) outcomes over 20 years were evaluated. Remission was defined as SAPS and SANS scores of less than 2 for more than 6 months and clinical recovery as no psychotic episode, psychiatric hospitalizations, and supported accommodation for 2 consecutive years.

Overall, data from 164 patients were available at 20 years. The follow-up cohort comprised patients with a mean age of 45.93 (SD, 5.47) years, 51.8% were women, 93.9% lived independently, 43.3% were a parent, 15.9% had completed 5 to 6 years of education after high school, and 14.9% had substance or alcohol use disorder. The patients who received EIS (n=84) or TAU (n=80) were well-balanced at follow-up, except that the EIS cohort was significantly older (mean, 46.78 vs 45.03 years; P =.04) than the TAU group, respectively.

The EIS recipients had significantly lower psychotic symptom dimension scores at the 1- (mean difference [MD], -0.30; P =.02) and 2- (MD, -0.34; P =.01) year follow-ups but no differences were observed at 5 (P =.58), 10 (P =.99), or 20 (P =.48) years compared with TAU. Similarly, the EIS recipients had lower negative symptom scores than TAU recipients at 1 (MD, -0.35; P =.001) and 2 (MD, -0.45; P =.001) years but not at the longer follow-ups. No differences in GAF-F scores were observed at any time.

Significant time-by-intervention interactions were observed for the negative symptom dimension (F_[4,267.896], 5.037; P ≤.001) and for GAF-F scores (F_[4,303.476], 2.501; P =.04) but not for psychotic symptom dimension (F_[4,283.695], 2.195; P =.07).

Excluding patients who had schizotypal disorders at baseline, the remission rates were 37.5% of 42 patients in the EIS group and 42% of 37 patients in the TAU group and the rates of clinical recovery were 14.1% and 21.2%, respectively.

No group differences in psychiatric hospitalizations (incidence rate ratio [IRR], 1.20; 95% CI, 0.73-2.00; P =.46) or outpatient contacts (IRR, 1.20; 95% CI, 0.89-1.61; P =.24) were observed.

The all-cause mortality rate at 20 years was 14.1% overall and the rates of death by suicide were 2.9% for EIS and 4.0% for TAU.

The major limitation of this study was the large attrition rate.

Researchers found that the results did not indicate that an EIS had long-term benefits for individuals with schizophrenia spectrum disorders, leading study authors to conclude, “New initiatives are needed to maintain the positive outcomes achieved after EIS and further improve long-term outcomes among individuals diagnosed with first-episode schizophrenia spectrum disorder.”

This article originally appeared on Psychiatry Advisor