First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial.
First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial.
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DOI：
10.1176/appi.ps.201400236
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Woods SW
中科院分区：
文献类型：
--
作者：
Srihari VH;Tek C;Kucukgoncu S;Phutane VH;Breitborde NJ;Pollard J;Ozkan B;Saksa J;Walsh BC;Woods SW
本研究旨在确定一个综合性的首次发作服务（精神病早期专门治疗诊所，STEP）的有效性，该诊所位于美国城市社区精神卫生中心，与常规治疗相比。这项实用的随机对照试验纳入了120名“首发精神病”患者，发病时间在5年内，服用抗精神病药物12周。转诊主要来自地区住院精神科，登记者被随机分配到STEP或转诊到常规护理（TU）。主要结果包括医院利用率（小学），工作能力，参加适龄学校教育或积极寻求这些机会（“职业技能”），和一般功能。分析是通过修改的意向治疗（仅排除3名撤回知情同意书的患者）进行的住院治疗和其他结局的完成者。一年后，STEP降低了所有住院患者利用率的指标，与常规治疗相比：（77% vs. 56%，RR 1.38，95%置信区间（CI）1.08-1.58）;平均住院（0.33±0.70 vs. 0.68±0.92，p=0.02）和平均住院天数（5.34±13.53 vs. 11.51±15.04，p=0.05）。对于每5例分配到STEP组与常规治疗组的患者，在第一年内有1例额外患者避免了精神病住院治疗（NNT = 5，CI 2.7-26.5）。STEP还提供了更好的职业参与度（91.7% vs. 66.7%，RR 1.40，95% CI 1.18-1.48）和全球功能测量的有益趋势。这项试验证明了美国公共部门早期干预精神病的可行性和有效性。这些服务还可以支持转化研究，是其他严重精神疾病的相关模式。www.ClinicalTrials.gov：NCT 00309452。
This study seeks to determine the effectiveness of a comprehensive first-episode service (the clinic for Specialized Treatment Early in Psychosis, STEP) based in an urban U.S. community mental health center, compared to treatment as usual. This pragmatic randomized controlled trial enrolled 120 ‘first-episode psychosis’ patients within 5 years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from area inpatient psychiatric units and enrollees were randomly allocated to STEP or referral to routine care (TU). Main outcomes included hospital utilization (primary), ability to work, attend age-appropriate schooling or actively seek these opportunities (‘vocational engagement’), and general functioning. Analysis was by modified intent to treat (excluding only 3 who withdrew consent) for hospitalization and completers for other outcomes. After one year, STEP effected reductions on all measures of inpatient utilization vs. usual treatment: not psychiatrically hospitalized (77% vs. 56%, RR 1.38, 95% confidence interval (CI) 1.08–1.58); mean hospitalizations (0.33±0.70 vs. 0.68±0.92, p=0.02) and mean bed days (5.34±13.53 vs. 11.51±15.04, p=0.05). For every 5 patients allocated in STEP vs. usual treatment, one additional patient avoided psychiatric hospitalization over the first year (NNT = 5, CI 2.7–26.5). STEP also delivered better vocational engagement (91.7% vs. 66.7%, RR 1.40, 95% CI 1.18–1.48) and salutary trends in measures of global functioning. This trial demonstrates the feasibility and effectiveness of a U.S. public sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses. www.ClinicalTrials.gov: NCT00309452.
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