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Integrated treatment for first-episode psychosis

Adult Mental Health
  Literature review updated September 2016.
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Studies in this review examined integrated treatment approaches for adolescents and young adults experiencing a first episode of psychosis. Intervention periods lasted between 9 and 24 months. Integrated treatment typically included making 3-4 of the following components available to patients: Assertive community treatment and case management, cognitive behavioral therapy for psychosis, social skills training, and family support/psychoeducation. Both treatment and comparison groups were offered anti-psychotic medication as indicated. In this review, integrative treatment is compared with treatment as usual through community mental health clinics.
 
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META-ANALYSIS
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Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Adjusted effect size(ES) and standard error(SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Global functioning
How well individuals (typically those who are developmentally disabled or seriously mentally ill) have adapted to activities of daily living.
 27 4 737 0.034 0.154 29 0.034 0.827
Hospitalization (psychiatric)
Admission to a psychiatric ward or hospital.
 27 4 654 -0.230 0.134 29 -0.230 0.085
Psychosis symptoms (positive)
Symptoms of psychosis that are experienced in addition to normal function (e.g., delusions, hallucinations, or agitation) measured on a validated scale, for individuals with serious mental illness.
 27 3 498 -0.292 0.148 29 -0.292 0.049
Psychiatric symptoms
Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.
 27 3 498 -0.298 0.085 29 -0.298 0.001
Mental health recovery
Full or partial recovery from psychosis symptoms specific to populations with a diagnosis of psychosis.
27 1 66 0.468 0.275 29 0.468 0.089
Psychosis symptoms (negative)
Symptoms of psychosis that reflect a decrease or loss of normal function (e.g., diminished emotional expression, lack of motivation) measured on a validated scale, for individuals with serious mental illness.
 27 3 498 -0.168 0.084 29 -0.168 0.046

Citations Used in the Meta-Analysis

Craig, T.K.J., Garety, P., Power, P., Rahaman, N., Colbert, S., Fornells-Ambrojo, M., & Dunn, G. (2004). The Lambeth Early Onset (LEO) Team: Randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal, 329(7474), 1067.

Petersen, L., Jeppesen, P., Thorup, A., Abel, M.-B., Ohlensclaeger, J., Christensen, T. O. . . . Nordentoft, M. (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal, 331(7517), 602-605.

Ruggeri, M., Bonetto, C., Lasalvia, A., Fioritti, A., de Girolamo, G., Santonastaso, P. . . . GET UP Group. (2015). Feasibility and effectiveness of a multi-element psychosocial intervention for first-episode psychosis: Results from the cluster-randomized controlled GET UP PIANO trial in a catchment area of 10 million inhabitants. Schizophrenia Bulletin, 41(5), 1192-1203.

Srihari, V.H., Tek, C., Kucukgoncu, S., Pollard, J., Saksa, J., Walsh, B.C. . . . Ozkan, B. (2015). First-episode services for psychotic disorders in the U.S. public sector: A pragmatic randomized controlled trial. Psychiatric Services, 66 (7), 705-712.