Do early intervention services impact long-term outcomes in patients with psychosis?
Early intervention services (EIS) specifically designed to meet the needs of patients with early-phase psychosis (EPS) and first-episode psychosis (FEP) have been an important part of mental health treatment over the past two decades. Professor Eric Chen, University of Hong Kong, Hong Kong summarised some of the research into the effect of EIS on outcomes in patients with psychosis at SIRS 2022.
Early intervention services (EIS) involve multidisciplinary teams that provide psychopharmacological and psychosocial interventions tailored to the needs of individual patients.
EIS significantly improve outcomes for patients with first-episode psychosis
In a meta-analysis of 10 randomised, controlled trials including more than 2000 patients with first-episode or early schizophrenia spectrum psychosis, EIS (duration 6─24 months) was associated with significantly improved outcomes during the treatment period for positive and negative symptoms, involvement in school or work, hospitalization, and treatment discontinuation, compared with treatment as usual.1
EIS significantly improve outcomes for patients with first-episode psychosis
Can short-term EIS impact long term outcomes?
Studies with ten-year follow-up from two years of EIS in Hong Kong showed that EIS lead to reduced risk of suicide, longer periods of employment, fewer and shorter duration of hospitalizations, and reduced risk of suicide, compared to standard care.2,3
In a recent randomised controlled trial in 360 patients with psychosis with a mean age of 38 years, randomised to EIS or standard care for either two or four years, patients treated with EIS for four years had significantly better functioning on the role functioning scale (RFS; interaction estimate=0.008, P=0.02) and significantly better extended social network (interaction estimate=0.011, P=0.003) compared with standard care. These improvements were specifically observed in the first two years, with the authors suggesting that treatment for up to four years provides little benefit over two years.4 Interestingly, four years of EIS had a greater impact on the RFS for patients with a long duration of untreated psychosis (DUP) compared to those with a shorter DUP, noted Professor Chen.4
Patients with longer duration of untreated psychosis (DUP) may be more responsive to longer EIS than those with shorter DUP
Biological and clinical critical periods may affect EIS outcome
The ‘critical period’ is an established biological concept for a time in which the brain has particular neuroplasticity, and is more easily influenced by environmental conditions. In schizophrenia, the critical period is considered as the first two to five years of early psychosis when deterioration occurs more aggressively. EIS starting from FEP can increase the likelihood of reduced or delayed neuroplastic changes that lead to chronic symptoms.5,6
EIS for first-episode psychosis may reduce or delay neuroplastic changes that lead to chronic symptoms
Factors that occur during the critical period can affect the outcome of EIS, but it is not ‘all or nothing’, said Professor Chen. There are factors that influence the critical period and others that do not, and there may also be overlap between biological and clinical critical periods. Modifiable factors that may influence the critical period include substance abuse, EIS duration and content, community acceptance of psychosis, social support networks, and patient choice.
Identifying factors for individual patients could affect EIS choice and improve outcomes.
Our correspondent’s highlights from the SIRS 2022 symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
AU-HLU-0031. May 2021
