Five-year outcome of first-episode psychosis before and after the implementation of a modified assertive community treatment programme.
OBJECTIVE
Assertive community treatment programmes are increasingly common worldwide but without much knowledge of their long-term effect. We investigated whether the implementation of such a programme would improve symptomatic and functional outcome 5 years later.


METHODS
Naturalistic cohort study between 1995 and 2000 of all first-episode psychosis patients (n = 144) in Uppsala County, Sweden. We compared a 3-year period before (non-mACT) and after the introduction of a modified assertive community treatment (mACT) programme in 1998. Five-year outcome was assessed for symptoms and functioning and the two co-primary outcome measures were positive and negative symptoms. Regression models were adjusted for a propensity score based on multiple baseline variables and use of antipsychotics at 5-year follow-up.


RESULTS
Contrary to our hypothesis, patients in the mACT group, compared to those in the non-mACT group, had a borderline significant increased risk of having a poor 5-year outcome regarding positive psychotic symptoms [adjusted odds ratio (OR) 3.21, 95% confidence interval (CI) 0.97-10.63]. There was no difference at the 5-year follow-up between the mACT and non-mACT group regarding negative symptoms (adjusted OR 1.65, 95% CI 0.48-5.66), or any of the secondary outcome measures: global assessment of functioning, hazardous alcohol use, use of illicit drugs, working or being in education, independent living, subjective satisfaction with life or suicide. Results were similar in subgroup analyses.


CONCLUSIONS
The implementation of a modified assertive community treatment was not followed by subsequent improvements of 5-year outcome on a group level for patients with first-episode psychosis.
Bodén
Robert
R
Department of Neuroscience, Psychiatry Ulleråker, Uppsala University Hospital, 750 17, Uppsala, Sweden. robert.boden@neuro.uu.se
Sundström
Johan
J
Lindström
Eva
E
Wieselgren
Ing-Marie
IM
Lindström
Leif
L
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013405:Suicide / Q000523:psychology; D013548:Sweden / Q000453:epidemiology; D013995:Time; D016896:Treatment Outcome
D014150:Antipsychotic Agents