Disorders - Psychosis Disorders
Li, C., Xia, J., Wang, J.
Background: Risperidone is a widely used antipsychotic drug for people with
schizophrenia. It is important to get a balance between gaining the most positive effects for the least negative outcomes. The optimal dose of
risperidone is the focus of this review.Objectives: To determine risperidone dose response relationships for schizophrenia and schizophrenia-like
psychoses.Search methods: We searched the Cochrane Schizophrenia Groups Trials Register (July 2008) for all relevant references.Selection criteria:
All relevant randomised controlled clinical trials (RCTs).Data collection and analysis: Two review authors independently extracted data and resolved
disagreement by discussion with a third member of the team. When insufficient data were provided, we contacted the study authors. For homogenous
dichotomous data we calculated fixed-effect relative risk (RR) and 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data,
we calculated weighted mean differences (MD).Main results: A consistent finding when risperidone ultra low doses (<2 mg/day) were compared with other
doses (short-term data) was that more people left early because of insufficient response (n=456, 1 RCT, RR when compared with standard-low (?4-<6
mg/day) 12.48 CI 1.43 to 4.30). The insufficient response for this low dose is reflected in measures of mental state. When low doses (?2-<4 mg/day)
are used and compared with standard-higher doses (?6-<10 mg/day) and the high dose range (?10 mg/day), more people left early because of insufficient
response (?4-<6 mg/day: n=173, 2 RCTs, RR 4.05 CI 1.09 to 15.07; ?10 mg/day: n=173, 2 RCTs, RR 1.92 CI 1.36 to 2.70). For the outcome of 'no
clinically important improvement' results favour standard-higher doses (n=272, 2 RCTs, RR 2.26 CI 0.81 to 6.34). When low doses are compared with
other higher doses, we found no differences in terms of cardiovascular, CNS, endocrine or gastrointestinal adverse effects. Unspecified EPS were more
frequent with the higher doses (?10 mg: n=262, 2 RCTs, RR 0.45 CI 0.24 to 0.84). One trial did find that endpoint scores on PANSS significantly
favoured a low dose when compared with ?4-6 mg/day (n=124, 1 RCT, MD -12.40 CI -17.01 to -7.79). When ?4-<6 mg/day is compared with high doses, less
people left early (n=677, 1 RCT, RR leaving any reason 0.74 CI 0.54 to 1.00; n=677, 1 RCT, RR due to adverse effects 0.56 CI 0.32 to 0.97). ?4-<6
mg/day was no worse than ?6-<10 mg/day for 'no clinically important improvement' (n=39, 1 RCT, RR on CGI-I 0.79 CI 0.29 to 2.17). People allocated
?4-<6 mg/day had more movement disorders than those on a low dose (n=124 1 RCT, RR 2.28 CI 1.67 to 3.11). When ?6-<10 mg/day is compared with
standard-lower doses and a high dose range, there is no significant difference in terms of proportions leaving early. ?6-<10 mg/day is better than a
low dose for 'no clinical important improvement' (n=172, 2 RCTs, RR 0.76 CI 0.61 to 0.94). Overall ?6-<10 mg/day caused less problems especially in
EPS when compared with ?10mg/day (n=261, 2 RCTs, RR unspecified EPS 0.56 CI 0.31 to 0.99). When a high dose was compared with a low dose less people
left early (n=70, 1 RCT, RR 0.43 CI 0.26 to 0.71) but not when compared with a standard-lower dose (n=677, 1 RCT, RR leaving due to adverse event
1.78 CI 1.03 to 3.09). ?10 mg/day was better than a low dose in terms of 'no clinical important improvement' (n=257, 2 RCTs, RR 0.64 CI 0.50 to
0.82), but worse than a standard-higher dose (?6-<10 mg/day: n=255, 2 RCTs, RR 1.22 CI 1.00 to 1.51). ?10 mg/day caused more unspecified EPS adverse
effects and any drug for adverse events when compared with a standard-higher dose and with a low dose.Authors' conclusions: There is still lack of
strong evidence for an optimal dose for clinical practice. The quality of trials suggests that an over estimate of effect is likely and we think this
is most probably for the mid-range doses. One such dose (standard-lower dose range, 4-<6 mg/day) does seem optimal for clinical response and adverse
effects Weak evidence suggests that low doses (?2-<4 mg/day) may be of value for people in their first episode of illness. High doses (?10 mg/day)
did not confer any advantage over any other dose ranges and caused more adverse effects, especially for movement disorders. Ultra low dose (<2
mg/day) seemed useless. We advise the use of dosages from low dose to standard-lower dose for different kinds of individual patients. Future trials
should focus on specific populations, e.g. those in their first episode, with acute exacerbation, in relapse or refractory to treatment, and should
also test the optimal dose of risperidone over a longer period of time and in the community.
Cochrane Database of Systematic
Reviews, (4) : CD007474
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
McGorry, Patrick D., Nelson, Barnaby, Amminger, G. Paul, Bechdolf, Andreas, Francey, Shona M., Berger, Gregor, Riecher-
Rossler, Anita, Klosterkotter,
Joachim, Ruhrmann, Stephan, Schultze-Lutter, Frauke, Nordentoft, Merete, Hickie, Ian, McGuire, Philip, Berk, Michael, Chen, Eric Y. H., Keshavan, Matcheri S., Yung, Alison R.
Objective: Data Sources: Study
Selection: Data Synthesis: Conclusions: Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initially, the
early psychosis movement focused on timely recognition and phase-specific treatment of first-episode psychosis. However, early psychosis researchers
suspected that pushing the point of intervention even further back to the prodromal phase of psychotic disorders may result in even better outcomes.
This article reviews intervention research in the ultra-high-risk phase of psychotic disorders.A literature search of intervention trials with
ultra-high-risk cohorts published after 1980 was conducted on PubMed with the search terms prodrome and intervention.All published intervention
trials with ultra-high-risk cohorts.The first generation of intervention trials indicated that both pharmacologic and psychological intervention
strategies may be of value in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder.Further controlled
intervention trials with larger sample sizes are required in order to confirm and extend these findings. We argue that the clinical staging model
provides a framework for the rationale and design of such studies, with simpler, safer, and more benign interventions being better candidates for
first-line treatment, while more complex and potentially harmful treatments should be reserved for those cases in which response has failed to occur.
Recent evidence indicates that neuroprotective agents, such as essential fatty acids, may be a suitable form of intervention for the ultra-high-risk
phase of psychotic disorders, with a positive risk-benefit balance. Ethical aspects have become more salient given the recently observed declining
transition rate in ultra-high-risk samples. We outline the key questions for the next generation of ultra-high-risk intervention trials.\rCopyright
2009 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 70(9) : 1206-
1212
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Morrison, Anthony P.
The main objective of this paper is to review the
literature regarding studies of cognitive behaviour therapy (CBT) for people with first episode psychosis or early psychosis. A comprehensive search
of the PsycINFO and MEDLINE databases identified twelve studies, including several randomised controlled trials and quasi-experimental studies. There
were few significant differences between groups at end of treatment or at follow-up, and no differences in rates of relapse or readmission. The
findings suggest, however, that CBT does have important benefits in terms of rate of recovery, improvements in certain symptoms (e.g. auditory
hallucinations and hopelessness) and quality of life. Thus, there is modest support for the application of CBT for people experiencing early
psychosis; however, the studies to date have difficulties with study design, theoretical underpinnings and how well the treatment targets fit with
the CBT model. Future research addressing these issues is required to determine whether CBT for early psychosis may prove to be more effective than
current data would suggest. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Psychosis:
Psychological, Social & Integrative Approaches, 1(2) : 103-
112
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Saksa, John R., Cohen, Shuki J., Srihari, Vinod H., Woods, Scott W.
Several recent studies of
individually administered cognitive behavior therapy (CBT) for early psychosis have reported only modest treatment benefits. The purpose of the
current study was to review the literature to determine how outcomes of group CBT differ from outcomes of individually administered CBT among early
cases. Our findings suggest that group CBT for early psychosis may be a more effective modality for this group of patients. We speculate that
patients' uncertainty about illness in general may impair the effectiveness of individually administered CBT for early cases and that group CBT may
be more effective for these young patients by better addressing those factors with the aid of peer-to-peer interactions, identification, and
modeling.
International Journal of Group
Psychotherapy, 59(3) : 357-383
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Salimi, Kayvon, Jarskog, L. Fredrik, Lieberman, Jeffrey A.
Increasingly, it is recognized that
first-episode schizophrenia represents a critical stage of illness during which the effectiveness of therapeutic interventions can affect long-term
outcome. In this regard, the advent of clozapine and subsequent atypical antipsychotic drugs held promise for improved outcomes in patients with
first-episode schizophrenia, given the expectation of improved therapeutic efficacy and a more benign side effect burden compared with typical
antipsychotic drugs. A growing number of large clinical trials have evaluated the merits of atypical antipsychotic drugs in the early stages of
psychosis. A number of conclusions can be drawn from studies completed to date, with the caveat that data are either limited or unavailable for the
antipsychotic drugs most recently approved by the US FDA. Studies of atypical antipsychotic drugs support data obtained with typical agents
indicating that positive symptoms of psychosis are very treatment responsive and generally at lower doses than in chronic illness. It also appears
that first-episode patients tend to stay on atypical antipsychotic drugs longer than on typical agents when all-cause discontinuation criteria are
considered as the primary outcome measure. However, there are few differential advantages of clinical efficacy among the individual atypical
antipsychotic drugs and there is little evidence to support distinct therapeutic advantages for negative symptoms or cognitive symptoms for atypical
agents. Furthermore, while new-onset psychosis patients are particularly susceptible to extrapyramidal symptoms, they are also prone to gain weight
and related metabolic adverse effects associated with many, but not all, atypical antipsychotic drugs. Recent data indicating that certain atypical
antipsychotic drugs may have a sparing effect on cortical grey matter loss in first-episode schizophrenia is intriguing, given the potential long-
term benefits. In summary, atypical antipsychotic drugs represent an incremental advance for patients in first-episode schizophrenia, especially in
the area of neurological tolerability. However, metabolic concerns associated with many atypical agents along with limited benefits in cognition and
negative symptom domains highlight the persistent therapeutic needs of these patients.
CNS Drugs, 23(10) : 837-
855
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Moller, Hans-
Jürgen, Riedel, Michael, Jager, Markus, Wickelmaier, Florian, Maier, Wolfgang, Kuhn, Kai-Uwe, Buchkremer, Gerhard, Heuser,
Isabella, Klosterkotter, Joachim, Gastpar, Markus
Patients with first-episode schizophrenia
appear to respond to lower doses of neuroleptics, and to be more\rsensitive to developing extrapyramidal side-effects. The authors therefore compared
in such patients the\refficacy and extrapyramidal tolerability of comparatively low dosages of the atypical neuroleptic risperidone\rand of the
conventional neuroleptic haloperidol. Risperidone was hypothesized to have better extrapyramidal\rtolerability and efficacy in treating negative
symptoms. Patients were randomly assigned under\rdouble-blind conditions to receive risperidone (n=143) or haloperidol (n=146) for 8 wk. The primary
\refficacy criterion was the estimated difference in the mean change in the Positive and Negative Symptom\rScale (PANSS) negative score between
treatment groups; secondary efficacy criteria were changes on the\rPANSS total score and other PANSS subscores, and several other measures of
psychopathology and general\rfunctioning. The primary tolerability criterion was the difference in baseline-adjusted occurrence rates of
\rextrapyramidal side-effects measured with the Simpson - Angus Scale (SAS) compared between treatment\rgroups. The main hypothesis was that
risperidone would be superior in terms of improving negative\rsymptoms and lowering the risk of extrapyramidal symptoms. Secondary tolerability
criteria were the other\rextrapyramidal symptoms, measured with the Hillside Akathisia Scale (HAS) and the Abnormal Involuntary\rMovement Scale
(AIMS). The average mean daily doses were 3.8 mg (S.D.=1.5) for risperidone and\r3.7 mg (S.D.=1.5) for haloperidol. There were similar, significant
improvements in both treatment groups in\rthe primary and secondary efficacy criteria. At week 8 nearly all scores of extrapyramidal side-effects
\rindicated a significantly higher prevalence of extrapyramidal side-effects with haloperidol than with\rrisperidone [SAS: risperidone 36.5% of
patients ; haloperidol 51.5% of patients ; likelihood ratio test,\rx2(1)=7.8, p=0.005]. There were significantly fewer drop-outs [risperidone n=55,
drop-out rate=38.5%;\rhaloperidol n=79, drop-out rate=54.1%, x2(1)=7.1, p=0.009] and a longer non-discontinuation time\r[risperidone: average of 50.8
d to drop-out ; haloperidol : average of 44.0 d to drop-out ; log rank test,\rx2(1)=6.4, p=0.011] in the risperidone group. Risperidone and
haloperidol appear to be equally effective in\rtreating negative and other symptoms of first-episode schizophrenia. Risperidone has better
extrapyramidal\rtolerability and treatment retention rate than the equivalent dose of haloperidol in these patients.
International Journal of
Neuropsychopharmacology, 11(07) : 985-997
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Kumra, S., Oberstar, J. V., Sikich, L., Findling, R. L., McClellan, J. M., Vinogradov,
S., Charles Schulz, S.
Early-onset schizophrenia-
spectrum (EOSS) disorders (onset of psychotic symptoms before 18 years of age) represent a severe variant associated with significant chronic
functional impairment and poor response to antipsychotic treatment. All drugs with proven antipsychotic effects block dopamine D 2
receptors to some degree. The ongoing development of the dopamine and other neurotransmitter receptor systems during childhood and adolescence may
affect clinical response and susceptibility to side effects in youth. A literature search was conducted of clinical trials of antipsychotics in
children and adolescents with EOSS disorders between 1980 and 2007 from the Medline database, reference lists, and conference proceedings. Trials
were limited to double-blind studies of duration of 4 or more weeks that included 15 or more patients. Ten clinical trials were identified.
Antipsychotic medications were consistently found to reduce the severity of psychotic symptoms in children and adolescents when compared with
placebo. The superiority of clozapine has been now demonstrated relative to haloperidol, standard-dose olanzapine, and \"high-dose\" olanzapine for
EOSS disorders. However, limited comparative data are available regarding whether there are differences among the remaining second-generation
antipsychotics (SGAs) in clinical effectiveness. The available data from short-term studies suggest that youth might be more sensitive than adults to
developing antipsychotic-related adverse side effects (eg, extrapyramidal side effects, sedation, prolactin elevation, weight gain). In addition,
preliminary data suggest that SGA use can lead to the development of diabetes in some youth, a disease which itself carries with it significant
morbidity and mortality. Such a substantial risk points to the urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain
and diabetes early in the course of treatment in this population. copyright 2007 The Authors.
Schizophrenia Bulletin., 34(1) : 60-
71
- Year: 2008
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Kumra, Sanjiv, Kranzler, Harvey, Gerbino-Rosen, Ginny, Kester, Hana M., DeThomas, Courtney, Kafantaris,
Vivian, Correll, Christoph U., Kane, John M.
BACKGROUND: The present study evaluated the effectiveness and safety of clozapine
versus \"high-dose\" olanzapine in treatment-refractory adolescents with schizophrenia. METHODS: Children, ages 10-18 years, who met DSM-IV criteria
for schizophrenia and who were resistant or intolerant to at least two antipsychotic drugs were randomized to receive 12 weeks of double-blind
flexibly dosed treatment with clozapine (n = 18) or \"high-dose\" olanzapine (up to 30 mg/day) (n = 21). The primary efficacy measure was response
(improvement), defined as a decrease of 30% or more in total Brief Psychiatric Rating Scale score from baseline and a Clinical Global Impression
Scale improvement rating of \"1\" (very much improved) or \"2\" (much improved). RESULTS: Significantly more clozapine-treated adolescents met
response criteria (66%) compared with olanzapine-treated subjects (33%). Clozapine was superior to olanzapine in terms of reduction of the psychosis
cluster scores and negative symptoms from baseline to end point. However, both treatments were associated with significant weight-gain and related
metabolic abnormalities. CONCLUSIONS: This double-blind randomized comparison of two second-generation antipsychotic drugs for treatment-refractory
adolescents with schizophrenia supports clozapine as the agent of choice. The development of interventions to limit weight gain and metabolic side
effects are needed to enhance the risk-benefit profile for both study treatments.
Biological Psychiatry, 63(5) : 524-
9
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Lecomte, Tania, Leclerc, Claude, Corbiere, Marc, Wykes, Til, Wallace,
Charles J., Spidel, Alicia
This study aimed at determining the effectiveness of group
cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness-
social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures
(baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom
management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in
improvements on positive and negative symptoms compared with the waitlist control group, with the CBT group having significant effects over time on
overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out
rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising
intervention for individuals with recent onset of psychosis and their mental health professionals. (PsycINFO Database Record (c) 2009 APA, all rights
reserved) (journal abstract).
Journal of Nervous & Mental Disease, 196(12) : 866-
875
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Skills training
Kahn, Rene S., Fleischhacker, W. Wolfgang, Boter, Han, Davidson, Michael, Vergouwe, Yvonne, Keet, Ireneus P.
M., Gheorghe, Mihai
D., Rybakowski, Janusz K., Galderisi, Silvana, Libiger, Jan, Hummer, Martina, Dollfus, Sonia, Lopez-Ibor, Juan J., Hranov, Luchezar G., Gaebel, Wolfgang, Peuskens, Joseph, Lindefors, Nils, Riecher-Rossler,
Anita, Grobbee, Diederick E., EufestStudyGroup
BACKGROUND: Second-generation antipsychotic drugs were introduced over a decade
ago for the treatment of schizophrenia; however, their purported clinical effectiveness compared with first-generation antipsychotic drugs is still
debated. We aimed to compare the effectiveness of second-generation antipsychotic drugs with that of a low dose of haloperidol, in first-episode
schizophrenia. METHODS: We did an open randomised controlled trial of haloperidol versus second-generation antipsychotic drugs in 50 sites, in 14
countries. Eligible patients were aged 18-40 years, and met diagnostic criteria for schizophrenia, schizophreniform disorder, or schizoaffective
disorder. 498 patients were randomly assigned by a web-based online system to haloperidol (1-4 mg per day; n=103), amisulpride (200-800 mg per day;
n=104), olanzapine (5-20 mg per day; n=105), quetiapine (200-750 mg per day; n=104), or ziprasidone (40-160 mg per day; n=82); follow-up was at 1
year. The primary outcome measure was all-cause treatment discontinuation. Patients and their treating physicians were not blinded to the assigned
treatment. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number
ISRCTN68736636. FINDINGS: The number of patients who discontinued treatment for any cause within 12 months was 63 (Kaplan-Meier estimate 72%) for
haloperidol, 32 (40%) for amisulpride, 30 (33%) for olanzapine, 51 (53%) for quetiapine, and 31 (45%) for ziprasidone. Comparisons with haloperidol
showed lower risks for any-cause discontinuation with amisulpride (hazard ratio [HR] 0.37, [95% CI 0.24-0.57]), olanzapine (HR 0.28 [0.18-0.43]),
quetiapine (HR 0.52 [0.35-0.76]), and ziprasidone (HR 0.51 [0.32-0.81]). However, symptom reductions were virtually the same in all the groups, at
around 60%. INTERPRETATION: This pragmatic trial suggests that clinically meaningful antipsychotic treatment of first-episode of schizophrenia is
achievable, for at least 1 year. However, we cannot conclude that second-generation drugs are more efficacious than is haloperidol, since
discontinuation rates are not necessarily consistent with symptomatic improvement.
Lancet, 371(9618) : 1085-
97
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Jackson, H. J., McGorry, P. D., Killackey, E., Bendall, S., Allott, K., Dudgeon, P., Gleeson, J., Johnson, T., Harrigan, S.
BACKGROUND: The ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a
cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as
Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and
negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained
at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up. METHOD: Two therapists
treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed
by independent raters on four primary outcome measures of symptoms and functioning: at pretreatment, the middle of treatment, the end of treatment
and at 1-year follow-up. An independent pair of raters assessed treatment integrity. RESULTS: Both groups improved significantly over time. ACE
significantly outperformed Befriending by improving functioning at mid-treatment, but it did not improve positive or negative symptoms. Past the
mid-treatment assessment, Befriending caught up with the ACE group and there were no significant differences in any outcome measure and in hospital
admissions at follow-up. CONCLUSIONS: There is some preliminary evidence that ACE promotes better early recovery in functioning and this finding
needs to be replicated in other independent research centres with larger samples.
Psychological Medicine, 38(5) : 725-
35
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Killackey, E.,
Jackson, H., & McGorry, P.
Unemployment is a major problem for people with first-
episode psychosis and schizophrenia. This has repercussions for the economy, social functioning and illness prognosis.\rAims\rTo examine whether a
vocational intervention - individual placement and support (PS) - which has been found to be beneficial in populations with chronic schizophrenia,
was a useful intervention for those with first-episode psychosis.\rMethod\rA total of 41 people with first-episode psychosis were randomised to
receive either 6 months of IPS + treatment as usual (TAU) (n=20) or TAU alone (n=21).\rResults\rThe IPS group had significantly better outcomes on
level of employment (13 v. 2, P<0.001), hours worked per week (median 38 v. 22.5, P=0.006), jobs acquired (23 v. 3) and longevity of employment
(median 5 weeks v. 0, P=0.021). The IPS group also significantly reduced their reliance on welfare benefits.\rConclusions\rIndividual placement and
support has good potential to address the problem of vocational outcome in people with first-episode psychosis. This has economic, social and health
implications.
British Journal of Psychiatry, 193(2) : 114-
120
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions