4-year outcome of a specialized early intervention treatment for adult onset psychosis (JCEP): A randomized controlled trial

Abstract

Despite advances in treatment of psychotic disorders, functional decline remains a prominent obstacle in the recovery pathway. Early intervention (EI) services worldwide have focused timely treatment on the first few years (i.e. critical period) of the disorder to prevent patients from developing long-term disabilities. However, the optimal intervention model and length remain unknown. The Jockey Club Early Psychosis (JCEP) Project delivered a specialized EI service for adult-onset first-episode psychosis patients aged 26 and 55 in Hong Kong. Using a randomized controlled trial, 360 patients were randomly assigned to receive either 4-year of EI treatment (n=120), 2-year of EI treatment (n=120), or 4-year of standard care (n=120). Clinical, functional and neurocognitive assessments were conducted at baseline, 6 months, and yearly until 4 years. By 4 years, it was found that the 4-year EI group had better cognitive outcome than the standard care group; and also better functional and cognitive outcome than the 2-year EI group. Subgroup analysis revealed that patients with longer duration of untreated psychosis (DUP) (≥94 days) benefited substantially more from 4-year EI, compared to 2-year EI. Patients with longer DUP who received 4-year EI had better functioning and cognitive outcome, while no additional benefit was observed in patients who had shorter treatment delay. JCEP evaluated the impact of EI by extending its duration to the entire 4 years. The consequence and implication of prolonged treatment to cover a longer hypothesized critical period will be discussed in this presentation.