An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST)
An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST)
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DOI：
10.1007/s00127-004-0754-4
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发表时间：
2004-05-01
影响因子：
4.4
通讯作者：
Tennakoon, L
中科院分区：
文献类型：
--
作者：
Kuipers, E;Holloway, F;Tennakoon, L
背景：。尽管人们对精神病的早期干预相当感兴趣，但其有效性的证据基础却很少。我们的目的是在第一年使用随机对照试验 (RCT) 来评估英国伦敦南部克罗伊登外展和自信支持团队 (COAST) 的一项新服务。方法 从当地成人社区心理健康团队转介那些在过去 5 年内有首次服务接触记录并被诊断为任何功能性精神病的人。同意的患者 (N = 59) 被随机分配接受 COAST 或照常治疗 (TAU)。 COAST 提供一系列干预措施，包括最佳非典型药物治疗、心理干预（个人认知行为治疗和家庭干预（如果合适））以及根据需要提供一系列职业和福利帮助。整个团队的培训被用来提供此类干预措施。结果 在基线、6 个月和 9 个月时，根据一系列标准化临床和社会指标对结果进行了评估。总体而言，随着时间的推移，COAST 和 TAU 客户端都得到了改善，但 COAST 客户端没有显着的改善；时间 x 治疗相互作用缺乏显着结果。 COAST 护理人员的生活质量有提高的趋势。 COAST 的就寝天数也较少，但差异并不显着。结论 COAST 缺乏明确的改进，这与迄今为止已发表的文献是一致的。一年来，两组患者的症状和功能均有所改善，这一事实表明，虽然获得早期干预很有帮助，但社区成人心理健康团队应致力于在精神病的任何阶段提供高质量的投入，以满足客户和护理人员的需求。
Background:. Despite considerable interest in early intervention in psychosis, the evidence base for its effectiveness is sparse.We aimed to evaluate a new service in South London, UK, Croydon Outreach and Assertive Support Team (COAST) using a randomised controlled trial (RCT) during its first year. Method Referrals were taken from local adult community mental health teams of those with documented first service contact in the last 5 years and a diagnosis of any functional psychosis. Those who consented (N = 59) were randomised to COAST or treatment as usual (TAU). COAST offered a range of interventions, including optimum atypical medication, psychological interventions (individual cognitive behavioural therapy and family intervention if appropriate) and a range of vocational and welfare help according to need. Whole team training was used to be able to offer these kinds of interventions. Results Outcomes were evaluated at baseline, 6 months and 9 months on a range of standardised clinical and social measures. Overall both COAST and TAU clients improved over time, but there were no significant improvements for COAST clients; a lack of significant results in the time x treatment interaction. There was a trend for COAST carers' quality of life to increase. Bed days were also less in COAST, but not significantly so. Conclusions The lack of clearly demonstrated improvements for COAST is consistent with the published literature so far. The fact that both groups improved in symptoms and functioning over the year suggests that while access to early intervention is helpful, community adult mental health teams should aim to offer high quality input at any stage of psychosis in order to meet client and carer needs.