A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness
A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness
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DOI：
10.1136/bmj.38565.415000.e01
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发表时间：
2005-09-17
影响因子：
105.7
通讯作者：
Nordentoft, M
中科院分区：
文献类型：
--
作者：
Petersen, L;Jeppesen, P;Nordentoft, M
目的 评价综合治疗对首发精神疾病患者的效果。设计随机临床试验。设置哥本哈根医院公司和丹麦奥尔胡斯精神病医院受试者 547 名首发精神分裂症谱系障碍患者。干预措施综合治疗和标准治疗。综合治疗持续了两年，包括积极的社区治疗以及家庭参与和社交技能培训计划。标准治疗提供与社区心理健康中心的联系。主要结果测量一年和两年随访中的精神病和阴性症状（每个评分从 0 到最大 5）。结果在一年的随访中，精神病症状有利地变为平均值 1.09（标准差 1.27），组间估计平均差异为 -0.31（95% 置信区间 -0.55 至 -0.07，P = 0.02）赞成综合治疗。阴性症状发生了有利的变化，组间估计差异为-0.36（-0.54至-0.17，P<0.001），有利于综合治疗。在两年的随访中，精神病症状组之间的估计平均差异为-0.32（-0.58至-0.06，P = 0.02），阴性症状为-0.45（-0.67至-0.22，P <0.001），两者都支持综合治疗。接受综合治疗的患者合并症物质滥用明显减少，治疗依从性更好，对治疗的满意度更高。结论综合治疗改善了临床结果和治疗依从性。临床结果的改善在一年和两年的随访中是一致的。
Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness.Design Randomised clinical trial.Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, DenmarkParticipants 547 patients With first episode of schizophrenia spectrum disorder.Interventions Integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training. Standard treatment offered contact With a community mental health centre.Main outcome measures Psychotic and negative symptoms (each scored from 0 to a maximum of 5) at one and two years' follow-up.Results At one year's follow-up, psychotic symptoms changed favourably to a mean of 1.09 (standard deviation 1.27) with an estimated mean difference between groups of -0.31 (95% confidence interval -0.55 to -0.07, P = 0.02) in favour of integrated treatment. Negative symptoms changed favourably with an estimated difference between groups of -0.36 (-0.54 to -0. 17, P < 0.001) in favour of integrated treatment. At two years' follow-up the estimated mean difference between groups in psychotic symptoms was -0.32 (-0.58 to -0.06, P = 0.02) and in negative symptoms was -0.45 (-0.67 to -0.22, P < 0.001), both in favour of integrated treatment. Patients who received integrated treatment had significantly less comorbid substance misuse, better adherence to treatment, and more satisfaction with treatment.Conclusion Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent at one year and two year follow-ups.