Early psychosis intervention programmes lead to improved outcomes

In people with first-episode psychosis, early psychosis intervention (EPI) programmes improve outcomes in mortality and other healthcare system indicators, a recent study has shown.

Using linked health administrative data, researchers determined the trends of EPI use in 1,522 individuals with incident, nonaffective psychosis. Cox proportional hazards models were used to compare outcomes, such as involuntary admissions and psychiatric hospitalizations, between those who did and did not use EPI services.

Compared to nonuser controls (n=992), the rate of contact with a primary care physician was significantly lower in those who used EPI services (n=530; hazard ratio [HR], 0.46; 95 percent CI, 0.41–0.52). The median time to first psychiatric contact after the programme was also shorter in those who did vs did not use EPI services (13 vs 73 days).

While rates of hospitalization were significantly higher in those who used EPI services relative to those who did not (HR, 1.42; 1.18–1.71), emergency department use was significantly lower (HR, 0.71; 0.60–0.83). Rates of involuntary admissions were statistically similar between the two groups (HR, 1.04; 0.88–1.22).

All-cause mortality was likewise significantly lower in those who availed of EPI services (HR, 0.24; 0.11–0.53), yielding an absolute risk difference of 2.5 percent. Self-harm behaviour (HR, 0.86; 0.18–4.24) and deaths by suicide (HR, 0.73; 0.29–1.80) were both statistically comparable between the groups.

However, the benefits of EPI did not appear to persist beyond the first 2 years. “[T]here was no significant advantage for EPI service users in the period between 2 and 5 years postadmission, when care is typically stepped down to medical management,” noted researchers.