08 May Psychosis: Early Integrated Bests Usual Care
MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Medical Director, Recognition and Prevention (RAP) Program
The Zucker Hillside Hospital, Department of Psychiatry
MedicalResearch.com: What is the background for this study?
Response: Schizophrenia and other psychotic disorders are still all to often chronic and recurring mental health conditions that not uncommonly take a course during which individuals have varying degrees of significantly impaired personal, social and educational/vocational functioning.
Prior individual studies examining early specialty intervention services, which integrate multiple different and complementary treatment components, had shown that this treatment approach can yield superior outcomes for people with early-phase schizophrenia and other psychotic disorders compared to usual care given to all people with psychotic disorders. However, we were lacking a broad overview of the type and results of treatment programs that had been conducted across different countries, continents and mental health service delivery systems. Moreover, we did not yet have a synthesis across all important outcomes that had been examined across these individual studies. This first comprehensive meta-analysis on this topic provides previously missing information on the different early intervention programs and their components as well as on all relevant outcomes for people who did or did not receiving early integrated care, also recently called ‘coordinated specialty care.’
MedicalResearch.com: What are the main findings?
Response: The main outcome of this research is that all measured outcomes indicated significantly greater benefits for people who had been randomized to receive early integrated care compared to those who received usual or community care. This means that not only early, but that integrated, multimodal care yielded better outcomes across the entire range of desired results. These positively affected outcomes included less treatment discontinuation, less inpatient hospitalizations, improved total, positive, negative and general symptom severity and improved depressive symptoms. Beyond these symptomatic gains, patients also had better global functioning, involvement in school/work, and quality of life, which are extremely important outcomes. Moreover, with very few exceptions, these gains were evident at each time point when the outcomes were measured.
MedicalResearch.com: What should readers take away from your report?
Response: While the studies assessed in our meta-analysis did not examine directly the question whether earlier interventions are superior to later interventions for people with early phase psychotic disorders, other research is very consistent and clear on this issue. The longer people are psychotic and the longer they do not receive adequate treatment, the poorer are both short- and long-term treatment outcomes. Our meta-analysis shows, however, that when care is initiated – which should always be as early as possible – then coordinated specialty care has the best chance to yield superior results.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Preliminary research indicates that relevant parts of the benefits that patients experience during early integrated care may be lost over time after they are moved to usual care. In contrast, extending early integrated care vs stopping it showed sustained benefits in some emerging studies. Thus, future studies need to examine the most beneficial duration of coordinated specialty care vs usual care beyond the currently tested time frame of up to 2 years. Studies also need to examine whether stepped care approaches would be beneficial whereby patients will receive both a flexible and adaptable amount of specialized integrated care and for individualized time periods that are guided by the individual patient’s needs and progress/response to treatment. Furthermore, research is needed to examine which elements of coordinated specialty care are particularly beneficial and for which patients, treatment time points and situations.
Disclosures: Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Alkermes, Allergan, Angelini, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Medavante, Medscape, Merck, Neurocrine, Otsuka, Pfizer, ROVI, Servier, Sunovion, Takeda, and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, ROVI and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma.
Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase PsychosisA Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry. Published online May 02, 2018. doi:10.1001/jamapsychiatry.2018.0623
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