Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India
Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India
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DOI：
10.1192/bjp.2020.126
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发表时间：
2020-09-01
影响因子：
10.5
通讯作者：
Joober, Ridha
中科院分区：
文献类型：
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作者：
Malla, Ashok;Iyer, Srividya N.;Joober, Ridha
在早期干预服务（EIS）的背景下，尚未对低收入和中等收入（LMICs）国家与高收入（HIC）国家相比精神病治疗的上级结局进行研究。目的：比较在钦奈（LMIC）和蒙特利尔（HIC）采用类似EIS治疗方案治疗首发精神病（FEP）的2年临床结局，并确定与任何结局差异相关的因素。方法比较钦奈（168例）和蒙特利尔（165例）在EIS治疗的FEP患者2年内症状水平的变化以及阳性和阴性症状缓解率和持续时间。进行重复测量方差分析、逻辑回归分析和线性回归分析。结果钦奈有4名患者死亡，蒙特利尔没有。钦奈患者的家庭支持更高（F= 14.05，d. f. = 1，P< 0.001，np（2）= 0.061），并且在两个位点随时间增加（F= 7.0，d. f. = 1.915，P < 0.001，np（2）= 0.03）。在钦奈，阴性症状结局在症状水平方面明显更好（时间x部位相互作用F = 7.36，d.f. = 1.49，P = 0.002，np（2）= 0.03），缓解时间（平均16.1v. 9.78月，t=-7.35，d.f.缓解率（81.5%v.60.3%，chi（2）= 16.12，d. f. = 1，P< 0.001）。在调整其他特征的研究中心间差异后，结果的研究中心差异仍然稳健。早期缓解和家庭支持有助于改善阴性症状的结局。在阳性症状结局方面没有观察到显著差异。结论与HIC患者相比，在LMIC背景下接受EIS治疗的FEP患者可能在阴性症状方面表现出更好的结局。早期缓解和家庭支持可能使这两种情况下的患者受益。
Background Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS). Aims To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences. Method Patients with FEP treated in EIS in Chennai (n= 168) and Montreal (n= 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted. Results Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F= 14.05, d.f. = 1,P< 0.001, np(2)= 0.061) and increased over time at both sites (F= 7.0, d.f. = 1.915,P< 0.001, np(2)= 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time x site interactionF= 7.36, d.f. = 1.49,P= 0.002, np(2)= 0.03), duration of remission (mean 16.1v. 9.78 months,t= -7.35, d.f. = 331,P< 0.001, Cohen'sd= 0.80) and the proportion of patients in remission (81.5%v. 60.3%, chi(2)= 16.12, d.f. = 1,P< 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes. Conclusions Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts.