title: First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial.
abstract: OBJECTIVE
  This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment.
  
  
  METHODS
  This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed.
  
  
  RESULTS
  After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR]=1.38, 95% confidence interval [CI]=1.08-1.58); mean hospitalizations, .33±.70 versus .68±.92 (p=.02); and mean bed-days, 5.34±13.53 versus 11.51±15.04 (p=.05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat=5; CI=2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR=1.40, CI=1.18-1.48) and showed salutary trends in global functioning measures.
  
  
  CONCLUSIONS
  This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses.
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Vinod H
authors: VH
authors: Srihari
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Cenk
authors: C
authors: Tek
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Suat
authors: S
authors: Kucukgoncu
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Vivek H
authors: VH
authors: Phutane
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Nicholas J K
authors: NJ
authors: Breitborde
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Jessica
authors: J
authors: Pollard
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Banu
authors: B
authors: Ozkan
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: John
authors: J
authors: Saksa
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Barbara C
authors: BC
authors: Walsh
authors: Dr. Srihari, Dr. Tek, Dr. Kucukgoncu, Dr. Pollard, Dr Saksa, Dr. Walsh, and Dr. Woods are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: vinod.srihari@yale.edu ). Dr. Phutane is with Goulburn Valley Health, Shepparton, Victoria, Australia. Dr. Breitborde is with the Department of Psychiatry, University of Arizona, Tucson. Dr. Ozkan is with the Department of Psychiatry, Koc University, Istanbul, Turkey. Findings of this study were presented at the International Conference on Early Psychosis, San Francisco, October 11-13, 2012. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section.
authors: Scott W
authors: SW
authors: Woods
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003155:Community Mental Health Centers; D061345:Early Medical Intervention; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000628:therapy*; D017150:Public Sector / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
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