Development of early intervention for psychosis program in Hong Kong and 10-year outcome evaluation of the service

Abstract

In Hong Kong, early intervention for psychosis program (EASY) was developed in 2001 as a territory wide service. It provided 2-year case management service to first-episode psychosis patients of age 15-25. There are convincing evidence on the short-term benefits of early intervention (EI) service for psychosis, including the EASY program in Hong Kong. However , long-term outcome studies are limited with inconsistent results. Current study has examined the 10-year outcomes of patients with first-episode psychosis who received two-year EI service (EASY) compared with those who received standard care (SC) in Hong Kong using historical control design. Consecutive patients who received EI service in the whole territory between 1st July 2001 and 30th June 2002, and with diagnosis of Schizophrenia-spectrum diagnosis, were identified and matched with patients who received SC first presented to the public psychiatric service from 1st July 2000 and 30th June 2001. 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on admission, functioning, suicidal attempts, mortality and relapse over 10 years was obtained from clinical database. 70.3% (N=104) of SC and 74.3% (N=110) of EI patients were successfully interviewed. Results suggested that EI patients had fewer number (OR=1.56, X2=15.64, p<0.0001) and shorter duration of hospitalization (OR=1.29, X2=4.06, p=0.04), longer employment period (OR=-0.28, X2=14.64, p<0.0001), less suicidal attempts (X2=11.47, df=1, p=0.001), better survival over 10 years. At 10-year, EI patients had less depressive symptoms (F(1.201)=5.78, p=0.02) though no difference was found on psychotic symptoms, symptomatic remission and functional recovery between groups. The short term benefits of EI service on number of hospitalization and employment sustained after termination of the service, but the differences narrowed down. This suggested the need of evaluating the optimal duration of EI service.