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First-episode services reduce hospitalizations for psychotic disorders

Patients who underwent first-episode services for schizophrenia or schizoaffective disorder required fewer hospitalizations and had greater vocational functioning compared with those administered usual care, according to study data.

“[Specialized Treatment Early in Psychosis] care reduced hospital utilization and improved vocational functioning within the first year of enrollment,” the researchers wrote. “Almost nine of every 10 patients entered the study from an acute care setting; however, more than three-quarters of Specialized Treatment Early in Psychosis patients avoided hospitalization over the first year of treatment, compared with a little over half of those allocated to usual treatment.”

Vinod H. Srihari

Vinod H. Srihari, MD, of the department of psychiatry at Yale University School of Medicine, and colleagues compared the outcomes of 120 patients with first-episode psychosis within 5 years of illness onset, and 12 weeks of antipsychotic exposure, randomly assigned to the clinic for Specialized Treatment Early in Psychosis (STEP) within the Connecticut Mental Health Center or usual care.

More than one-quarter of the patients enrolled met DSM-IV criteria for schizophrenia or schizoaffective disorder, according to data.

STEP utilization resulted in 20 hospitalizations compared with 39 in usual treatment, and patients assigned to STEP were less likely to be hospitalized (STEP: 23%, usual care: 44%).

When patients were hospitalized, those assigned to STEP were hospitalized an average of 6 fewer days compared with those in usual treatment. Fewer bed days were also observed among those in STEP (246 days) compared with usual care (495 days).

These findings were accompanied by improved vocational functioning among patients in STEP, who were more likely to be employed or in college or high school at least part-time, the researchers added. However, patients in usual care were more likely to leave their job (33%) compared with those assigned to STEP (8%). – by Samantha Costa

Disclosure: Srihari reports grants from the Donaghue Foundation and the NIH. Please see the full study for a list of all other authors’ relevant financial disclosures.