Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial.
BACKGROUND
Intensive early treatment for first-episode psychosis has been shown to be effective. It is unknown if the positive effects are sustained for 5 years.


OBJECTIVE
To determine the long-term effects of an intensive early-intervention program (OPUS) for first-episode psychotic patients.


METHODS
Single-blinded, randomized, controlled clinical trial of 2 years of an intensive early-intervention program vs standard treatment. Follow-up periods were 2 and 5 years.


METHODS
Copenhagen Hospital Corporation and Psychiatric Hospital, Aarhus, Denmark. Patients A total of 547 patients with a first episode of psychosis. Of these, 369 patients were participating in a 2-year follow-up, and 301 were participating in a 5-year follow-up. A total of 547 patients were followed for 5 years.


METHODS
Two years of an intensive early-intervention program vs standard treatment. The intensive early-intervention treatment consisted of assertive community treatment, family involvement, and social skills training. Standard treatment offered contact with a community mental health center.


METHODS
Psychotic and negative symptoms were recorded. Secondary outcome measures were use of services and social functioning.


RESULTS
Analysis was based on the principles of intention-to-treat. Assessment was blinded for previous treatment allocation. At the 5-year follow-up, the effect of treatment seen after 2 years (psychotic dimension odds ratio [OR], -0.32; 95% confidence interval [CI], -0.58 to -0.06; P = .02; negative dimension OR, -0.45; 95% CI, -0.67 to -0.22; P = .001) had equalized between the treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs 10%, respectively; OR, 2.3; 95% CI, 1.1-4.8; P = .02) and were hospitalized fewer days (mean, 149 vs 193 days; mean difference, 44 days; 95% CI, 0.15-88.12; P = .05) during the 5-year period.


CONCLUSIONS
The intensive early-intervention program improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years later. Secondary outcome measures showed differences in the proportion of patients living in supported housing and days in hospital at the 5-year follow-up in favor of the intensive early-intervention program.
Bertelsen
Mette
M
Bispebjerg Hospital, Department of Psychiatry, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. mbe_76@yahoo.dk
Jeppesen
Pia
P
Petersen
Lone
L
Thorup
Anne
A
Øhlenschlaeger
Johan
J
le Quach
Phuong
P
Christensen
Torben Østergaard
TØ
Krarup
Gertrud
G
Jørgensen
Per
P
Nordentoft
Merete
M
D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001242:Assertiveness; D003155:Community Mental Health Centers; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005196:Family Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D010507:Periodicity; D011340:Problem Solving; D016730:Program Development; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D055502:Secondary Prevention; D012720:Severity of Illness Index; D012951:Socialization; D013663:Teaching / Q000379:methods*; D013997:Time Factors
D014150:Antipsychotic Agents