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Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression

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Correll, Christoph U., Galling, Britta, Pawar, Aditya, Krivko, Anastasia, Bonetto, Chiara, Ruggeri, Mirella, Craig, Thomas J., Nordentoft, Merete, Srihari, Vinod H., Guloksuz, Sinan, Hui, Christy L. M., Chen, Eric Y. H., Valencia, Marcelo, Juarez, Francisco, Robinson, Delbert G., Schooler, Nina R., Brunette, Mary F., Mueser, Kim T., Rosenheck, Robert A., Marcy, Patricia, Addington, Jean, Estroff, Sue E., Robinson, James, Penn, David, Severe, Joanne B., Kane, John M.·2018·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2018.0623PMC PMC6137532

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Abstract

Importance: The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal. Objective: To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis. Data Sources: Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017. Study Selection: Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders. Data Extraction and Synthesis: This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses. Main Outcomes and Measures: The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period. Results: Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months). Conclusions and Relevance: In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.

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Authors: Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T. J., Nordentoft, M., Srihari, V. H., Guloksuz, S., Hui, C. L. M., Chen, E. Y. H., Valencia, M., Juarez, F., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., Marcy, P., Addington, J., Estroff, S. E., Robinson, J., Penn, D., Severe, J. B., & Kane, J. M.
Affiliations: Northwell Health (US)
University of Verona (IT)
Institute of Psychiatry, King’s College London, London, England
Copenhagen University Hospital (DK)
Yale University (US)
Department of Psychiatry, Yale University, New Haven, Connecticut
University of Hong Kong (HK)
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
Dartmouth College (US)
Boston University (US)
University of Calgary (CA)
University of North Carolina at Chapel Hill (US)
Nathan Kline Institute for Psychiatric Research (US)
National Institute of Mental Health (US)
Corresponding author: Correll, Christoph U.
ORCID: Correll, Christoph U.
Galling, Britta
Pawar, Aditya
Bonetto, Chiara
Ruggeri, Mirella
Nordentoft, Merete
Srihari, Vinod H.
Hui, Christy L. M.
Chen, Eric Y. H.
Robinson, Delbert G.
Schooler, Nina R.
Brunette, Mary F.
Mueser, Kim T.
Rosenheck, Robert A.
Marcy, Patricia
Addington, Jean
Penn, David
Kane, John M.
Venue: JAMA Psychiatry
Publisher: American Medical Association (AMA)
Published: 2018-06-01
Volume: 75
Issue: 6
Pages: 555
ISSN: 2168-622X (ISSN-L)
DOI: 10.1001/jamapsychiatry.2018.0623
PMC: PMC6137532
OpenAlex: W2799778639
Cited by: 826
References: 66
Citations by year: 2026: 106 · 2025: 110 · 2024: 115 · 2023: 96 · 2022: 118 · 2021: 105 · 2020: 95 · 2019: 68 · 2018: 13
FWCI: 55.28
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Psychiatry (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders: Patrick and Catherine Weldon Donaghue Medical Research Foundation
Bristol-Myers Squibb
Eli Lilly and Company
Sanofi
American Academy of Child and Adolescent Psychiatry
Sunovion
Wellcome Trust
National Institute for Health and Care Research
Lundbeckfonden (R155-2014-1724, R248‐2017‐2003)
Novo Nordisk
Allergan
National Institute of Mental Health (RC1MH088971, P30MH090590)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Keywords: early intervention services, first-episode psychosis, schizophrenia spectrum disorders, usual care, treatment discontinuation, psychiatric hospitalization, symptom severity, social functioning, public resource allocation, mental health services, randomized trial comparison, treatment duration
MeSH terms: Education, Employment, Hospitalization, Humans, Psychotic Disorders, Regression Analysis, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Randomized Controlled Trials as Topic, Early Medical Intervention

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Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression

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