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Five-Year Follow-up of a Randomized Multicenter Trial of Intensive Early Intervention vs Standard Treatment for Patients With a First Episode of Psychotic IllnessThe OPUS Trial
Mette Bertelsen, MSc;
Pia Jeppesen, MD, PhD;
Lone Petersen, PhD;
Anne Thorup, MD, PhD;
Johan Øhlenschlæger, MD, PhD;
Phuong le Quach, MD;
Torben Østergaard Christensen, PhD;
Gertrud Krarup, MD;
Per Jørgensen, MD;
Merete Nordentoft, MD, PhD, MPH
Arch Gen Psychiatry. 2008;65(7):762-771.
Context Intensive early treatment for first-episode psychosis has been shown to be effective. It is unknown if the positive effects are sustained for 5 years.
Objective To determine the long-term effects of an intensive early-intervention program (OPUS) for first-episode psychotic patients.
Design Single-blinded, randomized, controlled clinical trial of 2 years of an intensive early-intervention program vs standard treatment. Follow-up periods were 2 and 5 years.
Setting Copenhagen Hospital Corporation and Psychiatric Hospital, Aarhus, Denmark.
Patients A total of 547 patients with a first episode of psychosis. Of these, 369 patients were participating in a 2-year follow-up, and 301 were participating in a 5-year follow-up. A total of 547 patients were followed for 5 years.
Interventions Two years of an intensive early-intervention program vs standard treatment. The intensive early-intervention treatment consisted of assertive community treatment, family involvement, and social skills training. Standard treatment offered contact with a community mental health center.
Main Outcome Measures Psychotic and negative symptoms were recorded. Secondary outcome measures were use of services and social functioning.
Results Analysis was based on the principles of intention-to-treat. Assessment was blinded for previous treatment allocation. At the 5-year follow-up, the effect of treatment seen after 2 years (psychotic dimension odds ratio [OR], –0.32; 95% confidence interval [CI], – 0.58 to – 0.06; P = .02; negative dimension OR, – 0.45; 95% CI, – 0.67 to – 0.22; P = .001) had equalized between the treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs 10%, respectively; OR, 2.3; 95% CI, 1.1-4.8; P = .02) and were hospitalized fewer days (mean, 149 vs 193 days; mean difference, 44 days; 95% CI, 0.15-88.12; P = .05) during the 5-year period.
Conclusions The intensive early-intervention program improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years later. Secondary outcome measures showed differences in the proportion of patients living in supported housing and days in hospital at the 5-year follow-up in favor of the intensive early-intervention program.
Author Affiliations: Department of Psychiatry, Bispebjerg Hospital, and Copenhagen University Faculty of Health Science (Drs Bertelsen, Jeppesen, Petersen, Thorup, and Nordentoft); Sct Hans Hospital, Roskilde (Dr Øhlenschlæger); and Psychiatric Hospital Risskov, Risskov, Denmark (Drs Le Quach, Christensen, Krarup, and Jørgensen).
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