Disorders - Suicide or self-harm with comorbid mental disorder
Salpekar, J. A., Joshi, P. T., Axelson, D. A., Reinblatt, S. P., Yenokyan, G., Sanyal, A., Walkup, J. T., Vitiello, B., Luby, J. L., Wagner, K. D., Nusrat, N., Riddle, M. A.
Objective: To assess the efficacy of mood-stabilizing medications for depression and suicidality in pediatric bipolar disorder. Method: The Treatment of Early Age Mania (TEAM) study is a multicenter, prospective, randomized, masked comparison of divalproex sodium (VAL), lithium carbonate (LI), and risperidone (RISP) in an 8-week parallel clinical trial. A total of 279 children and adolescents with DSM-IV diagnoses of bipolar I disorder, mixed or manic, aged 6 to 15 years were enrolled. The primary outcome measure was improvement on the Clinical Global Impression scale for depression (CGI-BP-I-D). Secondary outcome measures included the Children's Depression Rating Scale (CDRS-R) and suicidality status. Statistics included longitudinal analysis of outcomes using generalized linear mixed models with random intercept both for the complete data set and by using last observation carried forward. Results: CGI-BP-I-D ratings were better in the RISP group (60.7%) as compared to the LI (42.2%; p = .03) or VAL (35.0%; p = .003) groups from baseline to the end of the study. CDRS scores in all treatment groups improved equally by study end. In week 1, scores were lower with RISP compared to VAL (mean = 4.72, 95% CI = 2.67, 6.78), and compared to LI (mean = 3.63, 95% CI = 1.51, 5.74), although group differences were not present by the end of the study. Suicidality was infrequent, and there was no overall effect of treatment on suicidality ratings. Conclusion: Depressive symptoms, present in the acutely manic or mixed phase of pediatric bipolar disorder, improved with all 3 medications, though RISP appeared to yield more rapid improvement than LI or VAL and was superior using a global categorical outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 54(12) : 999-1007
- Year: 2015
- Problem: Bipolar Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Anticonvulsants/mood stabilisers (excl. lithium), Lithium
Spirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C., Nugent, N., Zlotnick, C., Miller, I.
OBJECTIVE: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]).
METHODS: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE.
RESULTS: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups.
CONCLUSIONS: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.
Journal of Child & Adolescent Psychopharmacology, 25(2) : 131-9
- Year: 2015
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Spirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C., Nugent, N., Zlotnick, C., Miller, I.
Objective: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). Methods: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSMIV criteria for current or past MDE. Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. Conclusions: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Child & Adolescent Psychopharmacology, 25(2) : 131-139
- Year: 2015
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Brewer, W. J., Lambert, T. J., Witt, K., Dileo, J., Duff, C., Crlenjak, C., McGorry, P. D., Murphy, B. P.
Background: The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Methods: Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Findings: Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Interpretation: Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community. Funding: National Health & Medical Research Council and the Colonial Foundation.
Lancet Psychiatry, 2(1) : 29-37
- Year: 2015
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Case management
Ghaziuddin, N., Merchant, C., Dopp, R., King, C.
Objective: Describe suicidal ideation and suicide related/other emergencies (SRE), among depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization. Methods: One hundred twenty adolescents, who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication groups: SSRI antidepressant only (n = 71); SSRI plus mood stabilizer (n = 17); SSRI plus antipsychotic (n = 20); and SSRI plus antipsychotic and mood stabilizer (n = 12). Standardized instruments were used. Results: Mean age = 15.5 (plus or minus) 1.3, Caucasian = 80.8%, female = 74.2%, mean CDRS-R = 61.7 (plus or minus) 12.1, suicide attempt during month prior to hospitalization = 58.6%. During the 3-month post-hospitalization period: (1) there were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were associated with greater reduction in suicidal ideation at 3-months. Conclusion: Declines in suicidal ideation, depression severity, and suicide attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify medication adherence is a study limitation.
Asian Journal of Psychiatry, 11 : 13-19
- Year: 2014
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Anticonvulsants/mood stabilisers (excl. lithium)
Robinson, J., Cox, G., Hetrick, S.
Background: Suicide-related behaviours are common among young people. At least 100,000 adolescents complete suicide every year, and worldwide, suicide ranks in the top five causes of mortality among 15 - 19 year olds. Suicide attempt and suicidal ideation are more common, with just under 10% of adolescents reporting lifetime rates of attempted suicide, and almost 30% reporting a lifetime prevalence of suicidal ideation. A number of countries have developed national suicide prevention strategies with youth as one of the groups to be targeted, yet despite this, and despite the extent of this problem, little is known about the effectiveness of interventions to reduce risk, in both general and clinical populations. Thus the aims of this paper are to briefly describe the rates and risk factors associated with suicide-related behaviour in young people and the to examine in more detail the evidence for a range of interventions designed to reduce risk that could inform both clinical practice and government policy. Methods: Three systematic reviews, and one narrative review, were conducted in order to examine the range, and effectiveness, of interventions designed to reduce suicide risk among young people, in clinical, schoolbased and online settings. For each of the reviews conducted suicide-related behaviour had to be a primary outcome of interest. Results: Suicide prevention in clinical settings: Fifteen published trails were included. Of them two targeted young people with mood disorders, one targeted young people with borderline personality disorder and one study targeted young people with a psychotic disorder. Interventions included (but are not restricted to): medication, a family-based intervention, dialectical behavioural therapy, problem-solving therapy, cognitive behavioural therapy and group therapy. No differences were found between treatment and control groups except in one study that found a difference in rates of suicidal ideation between individual cognitive behavioural therapy and treatment as usual. Suicide prevention in school settings: Forty-three studies were included here, of which 15 reported on universal education or awareness programs, 23 reported on selective interventions (e.g. gatekeeper training and screening programs), 3 reported on targeted interventions, and 2 examined a postvention response in schools. Of these studies the most promising appeared to be gatekeeper training and screening programs, although more research is necessary. Suicide prevention in online settings: These reviews found that, despite the number, and potential effectiveness of, online programs for young people with depression and/or anxiety disorders, there are currently no published studies reporting on the effects of online therapy for suicidal youth. Similarly a number of studies have been found that discuss the relationship between suicide and social media, however despite the popularity and the potential reach of social media, no actual interventions studies were identified. Discussion: Overall it is concluded that whilst we know much about the epidemiology of suicide among youth, there is a dearth of well-conducted studies that provide adequate evidence regarding what works in youth suicide prevention. This has implications both clinically and at a policy level. A greater emphasis on intervention studies - including novel interventions would lead to better practice in terms of detecting and supporting suicidal young people, and could also contribute to a better informed, and more evidence-based, policy agenda around the world.
Schizophrenia Research, 153 : S10-S11
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Vaslamatzis, G., Theodoropoulos, P., Vondikaki, S., Karamanolaki, H., Miliatsanira, M., Gourounti, K.
The aim of this study was to compare the effectiveness of combined treatment - medication plus psychodynamic psychotherapy - and psychodynamic psychotherapy alone on the outcome variables of suicidality and impulsivity in a population of adult inpatients with severe personality disorder (SPD). This is a naturalistic-empirical (observational) study under the conditions of clinical practice (an intensive specialized inpatient psychotherapeutic program [SIPP]). The sample consisted of 33 inpatients with SPD who were allocated to two subgroups (groups A and B). The patients in group A received psychodynamic psychotherapy and adjunctive pharmacotherapy, whereas the patients in group B received multimodal psychodynamic psychotherapy only. A statistically significant reduction in suicidality score was observed in the patients in group A, whereas a tendency for significant reduction in impulsivity score was observed in group B after the SIPP termination. Pharmacotherapy combined with multimodal psychodynamic psychotherapy, always within the SIPP, seems more effective in the case of suicidality rather than impulsivity.©2014 Lippincott Williams & Wilkins.
Journal of Nervous & Mental Disease, 202(2) : 138-143
- Year: 2014
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Alavi, A., Sharifi, B., Ghanizadeh, A., Dehbozorgi, G.
Objective: To evaluate the effectiveness of a Cognitive-Behavioral therapy (CBT) for suicide prevention in decreasing suicidal ideation and hopelessness in a sample of depressed 12 to 18 year-old adolescents who had at least one previous suicidal attempt.; Methods: In a clinical trial, 30 depressed adolescents who attempted suicide in the recent 3 months were selected using simple sampling method and divided randomly into intervention and wait-list control groups. Both groups received psychiatric interventions as routine. The intervention group received a 12 session (once a week) of CBT program according to the package developed by Stanley et al, including psychoeducational interventions and individual and family skills training modules. All of the patients were evaluated by Scale for Suicidal Ideation, Beck's hopelessness Inventory, and Beck's Depression Inventory before the intervention and after 12 weeks.; Findings: There were significant differences between the two groups regarding the scores of the above mentioned scales after 12 weeks. Fifty-four to 77 percent decreases in the mean scores of the used scales were observed in the invention group. There were no significant changes in the scores of the control wait-list group. The differences between pre- and post-intervention scores in the intervention group were significant.; Conclusion: CBT is an effective method in reducing suicidal ideation and hopelessness in the depressed adolescents with previous suicidal attempts.;
Iranian Journal of Pediatrics, 23(4) : 467-472
- Year: 2013
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Crowe, M., Inder, M., Moor, S., Luty, S. E., Carter, J.
Objective: Rates of attempting and completing suicide are high in Bipolar Disorder (BD) with death due to suicide in 10-15% of patients (Simon, Hunkeler et al. 2007), up to 60-fold higher than in the general population (Neves, Malloy-Dinez et al. 2009). The high lethality of suicidal acts in bipolar disorders is suggested by a much lower ratio of attempts: suicide (approximately 3:1) than in the general population (approximately 30:1) (Baldessarini, Tondo et al. 2006). The association between BD and suicide attempts is wellestablished, however there is fairly limited prospective data reported and many studies exclude patients who have alcohol and/ or drug abuse/dependence, other Axis 1 comorbidity or suicidal ideation (Crowe, Whitehead et al. 2010). Methods: One hundred young people (15-36 years) were recruited to take part in an 18-month randomised controlled trial of Interpersonal and Social Rhythm Therapy (IPSRT) and Specialist Supportive Care (SSC). Participants were randomised to each therapy in addition to medication management from a psychiatrist. Data on lifetime suicide attempts was collected as baseline weeks 26, 52, 78, 104, 130, and 156, with additional questions on suicidal behaviour. Descriptive analyses including frequencies, percentages, means and standard deviations were undertaken on demographic, clinical and suicide data. Chi-square analyses and independent t-test were done to compare the characteristics of those participants who completed with those who were non-completers. Results: At baseline previous suicide attempts were common with 48 participants (7 males, 41 females) assessed by the treating psychiatrist as having attempted suicide. In the six months preceding the study, a total of 11 (22.9%) individuals, all female, made suicide attempts. The vast majority of participants at the time of the attempt indicated they wished to die with 2/3rds believing their attempt would result in death. In the 6 months prior to the study commencement, there were a total of 11 individuals who made attempts with a total of 18 actual attempts made. Over the course of the intervention and follow up period (156 weeks), 15 individuals made subsequent suicide attempts with a total of 28 attempts. During the course of the study there was one death by suicide. There were no statistical differences found in demographic, clinical or suicidal behaviour characteristics indicating no significant differences in these groups. Discussion: There were no statistical differences in the characteristics of suicide risk factors (gender, age, age of onset, previous attempts, substance or alcohol use disorder and anxiety disorder) between those we were able to follow-up (n = 73) and those that were lost to follow-up (n = 27). While there may be an association between the psychotherapy interventions and the reduction in suicide attempts, there are also other possible factors that could explain this. Larger numbers would be required before an association could be made more definitively. However these results add to the growing evidence that adjunctive psychosocial interventions may contribute to a reduction in suicide risk in bipolar individuals.
Bipolar Disorders, 15 : 97
- Year: 2013
- Problem: Bipolar Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Gleeson, J. F. M., Chanen, A., Cotton, S. M., Pearce, T., Newman, B., McCutcheon, L.
Aim: First-episode psychosis and borderline personality disorder are severe mental disorders that have their onset in youth. Their co-occurrence is clinically well recognized, is associated with significant risks and is complex to treat. Yet, there is no published specific intervention for this problem. This study reports a pilot randomized controlled trial comparing combined specialist first-episode treatment plus specialist early intervention for borderline personality, entitled Helping Young People Early, with specialist first-episode treatment alone. We aimed to evaluate the safety and feasibility of adding early intervention for borderline personality. Methods: The study investigated the safety of specialist first-episode treatment plus specialist early intervention for borderline personality in relation to deterioration in psychosis, aggression, self-harm and suicidality, and feasibility in relation to the completion of therapy phases. Sixteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) criteria for first-episode psychosis and borderline personality (four or more DSM-IV criteria) were randomized either to specialist first-episode treatment alone or specialist first-episode treatment plus specialist early intervention for borderline personality and were followed up at the end of treatment and 6months later. Results: The results showed that it was feasible to recruit and assess a high risk and complex group of patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality was an acceptable and safe treatment. Conclusion: A larger-scale randomized controlled trial of early intervention for borderline personality for young first-episode psychosis patients with co-occurring full or subsyndromal borderline personality is warranted. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(1) : 21-29
- Year: 2012
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive analytic therapy (CAT)
, Case management
Andion, O., Ferrer, M., Matali, J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., Casas, M.
Dialectical behavior therapy (DBT) is an effective therapy. However, treating borderline personality disorder (BPD) patients with standard DBT can be problematic in some institutions due to logistical or cost limitations. The aim of this preliminary study is to examine the efficacy of Individual DBT in 37 BPD patients, compared with Combined individual/Group DBT in 14 BPD patients. Outcome measures included suicide attempts, self-harm behaviors, and visits to emergency departments. These variables were examined at pretreatment, 12 months/end of treatment, and at an 18-month follow-up. In addition, dropout rates were examined. Significant improvements on the outcome measures were observed across both versions of DBT treatment, particularly at the 18-month follow-up assessment. No significant differences were observed between Individual DBT and Combined individual/Group DBT on any of the posttreatment evaluations. An individual version of DBT may be an effective and less costly option for BPD treatment. Larger controlled trials are needed to confirm the results. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Psychotherapy, 49(2) : 241-250
- Year: 2012
- Problem: Non-suicidal self-harm behaviours
, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Dialectical behavioural therapy (DBT)
Chen, E. Y. H., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., Yew, C. W., Wong, G. H., Chung, D. W., Tso, S., Chan, K. P., Yip, K. C., Hung, S. F., Honer, W. G.
Aim: Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis. Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records. Results: Patients in the early intervention group had longer full-time employment or study (P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P=0.001), fewer suicides (P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72). Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 5(4) : 315-323
- Year: 2011
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions