Hopeful News on Comprehensive Team Treatment of Early Psychosis

Hopeful News on Comprehensive Team Treatment of Early Psychosis

Posted: October 22, 2015
Hopeful News on Comprehensive Team Treatment of Early Psychosis

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There is hopeful news for people suffering from psychosis. Early intervention and coordinated team care can make a real, positive difference in outcomes for first-episode psychosis patients; and there is a way of delivering such care that has been demonstrated to work effectively in a series of randomly selected community-based mental health clinics located in various places across the United States.

These and other important related results are based on two years of treating patients in the NAVIGATE program, which was evaluated in the RAISE Early Treatment Program (ETP), organized by the National Institute of Mental Health (NIMH).

The research team, reporting October 20th in the American Journal of Psychiatry, was led by John M. Kane, M.D., of Hofstra North Shore-LIJ School of Medicine, and included seven recipients of Foundation Grants, including Foundation Scientific Council Member Nina R. Schooler, Ph.D. (1998 Distinguished Investigator grantee), and Kim T. Mueser, Ph.D. (2003 Distinguished Investigator and 1988, 1989 Young Investigator).

At the heart of the program studied in RAISE ETP is a team-based treatment program called NAVIGATE, which includes: comprehensive first-episode psychosis intervention that emphasizes low-dose antipsychotic medications; cognitive-behavioral therapy to increase resiliency and illness self-management skills for the patient; family psychoeducation and support; and supported employment and education.

And the good news is that 223 people who received the NAVIGATE treatment approach:

  1. remained in treatment longer
  2. experienced greater improvement in quality of life, including interpersonal relationships
  3. experienced greater relief from overall symptoms as well as depression
  4. improved more in involvement in work and school, when compared with 181 people with a similar history (a single episode of psychosis) who received the usual care offered in community care settings.

Two important observations based on 2 years of clinical testing of the NAVIGATE approach merit special attention. One was that earlier implementation of the full, coordinated treatment approach following a first episode of psychosis correlated directly with better outcome. This points to the concrete value of early intervention and reducing the duration of untreated psychosis.

A second notable observation: patients who received the full coordinated treatment needed lower doses of antipsychotic medication, on average, to maintain a good quality of life. Unwanted side-effects of antipsychotics, including weight gain and tremor-like symptoms, have long been a problem for patients. Treatment programs like NAVIGATE that can enable patients to fare well on lower doses have long been sought.

The authors of the study summed up their results this way:

“The study demonstrates that diverse US community clinics can implement a team-based model of first-episode psychosis care, producing greater improvement in clinical and functional outcomes as compared with standard care. These effects were more pronounced for those with shorter duration of untreated psychosis, suggesting that the receipt of appropriate first-episode psychosis treatment at the proper time in the illness course can have a substantial impact on outcomes.”

Jeffrey Borenstein, M.D., the Foundation’s President and CEO, had this comment on the newly reported results:

“This study demonstrates the importance of an approach to treatment for people with schizophrenia that includes psychotherapy, family involvement, and additional support for patients and their families in addition to medication. With appropriate care and support, many people are able to regain their health and live full, produce and happy lives. Unfortunately, too many people do not receive this level of care. While this study is a step forward, we need to put funding into additional research to develop even more effective methods of treatment and prevention.”

Look for more about this study in upcoming issues of the Foundation’s magazine, The Quarterly.

Other Foundation grant recipients involved in the RAISE project and NAVIGATE treatment trial include: Delbert G. Robinson, M.D., 2005 Independent Investigator; Mary F. Brunette, M.D., 2000 Young Investigator; Christoph U. Correll, M.D., 2007 Young Investigator; Jennifer D. Gottlieb, Ph.D., 2009 Young Investigator; Robert K. Heinssen, Ph.D., 1990 Young Investigator.