Early intervention benefits may not stay the course in psychosis

By Eleanor McDermid, Senior medwireNews Reporter

Most of the benefits of a specialised early intervention for psychosis have disappeared by 8 years after its completion, shows follow-up of the OPUS trial.

Intensive early intervention is intended to alter the long-term course of psychosis. However, the researchers found that early improvements in psychotic symptoms, negative symptoms and secondary outcomes, relative to treatment as usual, diminished over the course of long-term follow-up.

Nevertheless, they found some evidence of persistent benefit, especially earlier in the course of follow-up. “Thus, it could be prudent to investigate if the positive effects of OPUS can be extended, eg, by lengthening the duration of the intervention from 2 to 5 years”, write Carsten Rygaard Hjorthøj (Copenhagen University Hospital, Denmark) and co-workers in Schizophrenia Bulletin.

The OPUS trial recruited 547 patients with a first episode of nonaffective psychosis between 1998 and 2000. Registry data for these patients revealed just one significant finding after 10 years of follow-up; patients who had received 2 years of the OPUS treatment (Assertive Community Treatment, psychoeducational family intervention and social skills training) before switching to treatment as usual were more likely to have spent at least 1 day in a homeless shelter during the past year than patients who received only usual treatment (2.0 vs 0.4%).

But the researchers say that this involved only very small numbers in both groups. “It is also worth noting that it is not known if the alternative to staying in a homeless shelter would have been living on the streets, in which case the difference would be in favor of the OPUS group.”

Other outcomes were similar between the two groups, and this was also the case among 347 patients who were interviewed at the 10-year follow-up, with initial improvements in psychotic, negative and disorganised symptoms in the OPUS group disappearing. A similar proportion of the OPUS and usual treatment groups were using antipsychotics (57.2 and 60.2%, respectively) and had experienced suicide ideation in the previous 2 years (39.4 and 37.9%, respectively).

However, the researchers argue that “[t]he near-absence of long-term between-group differences does not necessarily indicate that OPUS is not efficient in the long run.”

Later treatments in both groups, including inpatient treatment, could have diluted the effects of OPUS treatment, they suggest. And some mental health centres may have subsequently adopted elements of OPUS treatment, thus improving the efficacy of usual treatment.

The team also notes that patients in the OPUS group had to switch to usual treatment after 2 years, requiring them to build a relationship with a new case manager.

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