Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders.
BACKGROUND
The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.


METHODS
A total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.


RESULTS
It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.


CONCLUSIONS
The study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.
Nordentoft
M
M
Copenhagen University, Faculty of Health Sciences, Psychiatric Centre Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. mn@dadlnet.dk
Øhlenschlaeger
J
J
Thorup
A
A
Petersen
L
L
Jeppesen
Pia
P
Bertelsen
M
M
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003688:Deinstitutionalization; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006798:Housing; D006801:Humans; D007902:Length of Stay; D008297:Male; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy; D012559:Schizophrenia / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents