Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program.
Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program.
复制标题
DOI：
10.1176/appi.ajp.2015.15050632
复制
发表时间：
2016-04-01
期刊：
影响因子：
--
通讯作者：
Heinssen RK
中科院分区：
文献类型：
--
作者：
Kane JM;Robinson DG;Schooler NR;Mueser KT;Penn DL;Rosenheck RA;Addington J;Brunette MF;Correll CU;Estroff SE;Marcy P;Robinson J;Meyer-Kalos PS;Gottlieb JD;Glynn SM;Lynde DW;Pipes R;Kurian BT;Miller AL;Azrin ST;Goldstein AB;Severe JB;Lin H;Sint KJ;John M;Heinssen RK
主要目的是比较NAVIGATE与社区护理对生活质量的影响，NAVIGATE是一种针对首次精神病发作的综合性、多学科、基于团队的治疗方法，旨在在美国医疗保健系统中实施。21个州的34家诊所被随机分配到NAVIGATE或社区护理。诊断，未治疗的精神病的持续时间和临床结果通过现场，双向视频进行评估，由远程，集中的评价者对研究设计和治疗不知情。入选了患有精神分裂症和相关疾病且抗精神病药物治疗≤6个月的受试者（平均年龄23岁）（N=404），并随访≥2年。主要结果是Heinrichs-Carpenter生活质量量表的总分，该量表包括目的感、动机、情感和社会互动、角色功能和参与常规活动。与181名社区护理参与者相比，223名NAVIGATE接受者的治疗时间更长，在生活质量、精神病理学和工作/学校参与方面的改善更大。未经治疗的精神病的中位持续时间=74周。与精神病未经治疗持续时间较长的人和社区护理中的人相比，精神病未经治疗持续时间<74周的NAVIGATE参与者的生活质量和精神病理学改善更大。与其他首发精神病临床试验相比，住院率相对较低，组间无差异。对首发精神病的全面护理可以在美国社区诊所实施。并改善功能和临床结果。对于那些未经治疗的精神病持续时间较短的人，效果更为明显。
The primary aim was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis designed for implementation in the U.S. healthcare system, to Community Care on quality of life. Thirty-four clinics in 21 states were randomly assigned to NAVIGATE or Community Care. Diagnosis, duration of untreated psychosis and clinical outcomes were assessed via live, two-way video by remote, centralized raters masked to study design and treatment. Participants (mean age 23) with schizophrenia and related disorders and ≤6 months antipsychotic treatment (N=404) were enrolled and followed for ≥2 years. The primary outcome was the Total Score of the Heinrichs-Carpenter Quality of Life Scale, a measure that includes sense of purpose, motivation, emotional and social interactions, role functioning and engagement in regular activities. 223 NAVIGATE recipients remained in treatment longer, experienced greater improvement in quality of life, psychopathology and involvement in work/school compared to 181 Community Care participants. The median duration of untreated psychosis=74 weeks. NAVIGATE participants with duration of untreated psychosis <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in Community Care. Rates of hospitalization were relatively low compared to other first episode psychosis clinical trials and did not differ between groups. Comprehensive care for first episode psychosis can be implemented in U.S. community clinics. and improves functional and clinical outcomes. Effects are more pronounced for those with shorter duration of untreated psychosis.