Two randomized controlled studies of psychosocial interventions in severe psychotic illness.
Prosjekt
- Prosjektnummer
- 46055600-59
- Ansvarlig person
- Vidir Sigrunarson
- Institusjon
- St. Olavs Hospital
- Prosjektkategori
- korttidsprosjekt 2014
- Helsekategori
- Mental Health
- Forskningsaktivitet
- 5. Treatment Developement
Rapporter
Two randomized controlled studies of psychosocial inteventions in severe psychotic illness
The aims of the 2 RCT studies is to compare the 12-year follow-up effects of 2 years of integrated treatment for recent-onset schizophrenia and describe predictors of good outcome (Study 1) and to investigate the effects of “patient guided psychiatric admissions” for patients with severe psychotic disorders (Study 2).Study 1:
A cohort of 50 patients with recent-onset schizophrenia was included in a RCT comparing early integrated treatment (IT) with treatment as usual (TAU). Recent onset was defined as emergence of psychotic symptoms for the first time during the preceding 2 years. TAU comprised optimal pharmacotherapy and case management, while IT also included cognitive-behavioral family treatment, which incorporated skills training, cognitive-behavioral strategies for residual psychotic and non-psychotic problems and home-based crisis management as in the modern ACT teams. Patients were included from 1992 to 1997. The catchment area was Sør-Trøndelag County with a population of about 250.000 inhabitants. At the time of inclusions, no effort was made to reduce the delay in seeking treatment in this region, but efforts were made to get referrals of all patients with recent onset psychotic disorder from psychiatric inpatient units, outpatient clinics, and general practitioners in the area. Patients who were clinically stable and were expected to reside in the county for at least 1 year after inclusion were asked to participate in the study. Patients with substance use disorders or mental retardation were excluded. The results after two years of treatment have been published in three papers.
Follow up: The follow up period was from the date of randomization and until 12 years after termination of treatment trial, 14 years forward. Data on duration of hospital admissions during these 14 years was extracted from the official Patient Administrative System, a standard system for clinical data in the health trust. Data was verified trough scrutiny and cross-checking of medical records.
Results: ! No differences in number of days in hospital, time to readmission, number of admittances to psychiatric wards, number of involuntarily psychiatric admissions or number of outpatient contacts over a period of 12 years following the initial 2-year treatment trial. Fewer patients in the IT group were involuntary admitted to hospital.
Result 2: Article published in MMC Psychiatry in january 2017. PMID:28088223
Study 2:
In Nidaros DPS, two of 17 beds at the rehabilitation section were converted into “self-referral to inpatient beds” reserved for patients with severe psychotic disorders who had earlier been admitted to the section. Patients in the “self-referral to inpatient beds” group signed a contract stating that they could administer their own admissions to the section, without referral from a doctor. The stay should be as short as possible; maximum 5 days, and there had to be a 14 days gap between admissions. The wait-list control group had admission procedures as usual. Participants in the wait-list control group were secured a contract on “patient guided psychiatric admission” one year after inclusion. Inclusion criteria were: Schizophrenia or bipolar disorder, 18 years or older, long term care and established relationship with the ward. Exclusion criteria were: Extensive substance use problems, self-destructive behavior or not being able to consent. The study was approved by The Regional Committee for Medical and Health Research Ethics in Central-Norway. From September 2010, 50 individuals were recruited and randomized.
Results: Article publsihed in Nordic Journal of Psychiatry: No significant differences in the use of inpatient services during the 12 mth intervention period. PMID: 27739334
The subject of study 1 was to compare the long term effects of two years of integrated treatment for recent onset schizophrenia vs treatment as usual. The subject of study 2 was to evaluate the effect of a service called "self-referral to inpatient treatment" for patients with severe psychotic disorders.Study I
The subject of this randomized controlled study is the comparison of long term effects of two years of integrated treatment (IT) for recent onset schizophrenia vs. treatment as usual (TAU) on hospital admissions, outpatient contacts, use of involuntary admissions and outpatient coercion. ??The patients were consecutive patients with recent onset non-affective psychosis admitted to hospital from a catchment area. Thirty patients received IT and 20 TAU. IT consisted of TAU in addition to cognitive–behavioral family communication and problem solving skills training, individual cognitive-behavioral strategies for residual symptoms and disability, structured family psycho-education and assertive out-reach crisis management provided at home??The main conclusions are that apart from significantly fewer IT-patients being involuntary admitted there are no differences between the IT group and the TAU group twelve years after end of treatment trial. We also found that a small proportion of the patients stood for a large majority of use of services and a large proportion of the participants had very limited use of services.?
StudyII
There has been a call for increased patient autonomy and participation in treatment decisions in psychiatry. Some Community Mental Health Centers (CMHC) have implemented services called “self-referral to inpatient treatment” (SRIT) for patients with severe psychotic disorders. The aims of the present study were to investigate whether SRIT could yield better outcomes in 12 months in terms of use of mental health services for people with severe psychotic disorders than Treatment As Usual (TAU). Methods: This was a randomized controlled trial at a CMHC in Central Norway comparing SRIT and TAU. 54 patients with severe psychotic disorder were included. The patients in the SRIT group could admit themselves as inpatients for up to five days for each admission with at least a two weeks pause between the admittances. Results: With the exception of larger number of admissions at the CMHC in the SRIT group, no significant differences were found between the two groups in days as inpatients (81 vs 67), admissions, outpatient contacts or coercion. Conclusions: SRIT seemed to have no effects on use of services during the 12 months intervention period compared to TAU.
The aims of the 2 RCT studies is to compare the 12-year follow-up effects of 2 years of integrated treatment for recent-onset schizophrenia and describe predictors of good outcome (Study 1) and to investigate the effects of “patient guided psychiatric admissions” for patients with severe psychotic disorders (Study 2).Study 1:
A cohort of 50 patients with recent-onset schizophrenia was included in a RCT comparing early integrated treatment (IT) with treatment as usual (TAU). Recent onset was defined as emergence of psychotic symptoms for the first time during the preceding 2 years. TAU comprised optimal pharmacotherapy and case management, while IT also included cognitive-behavioral family treatment, which incorporated skills training, cognitive-behavioral strategies for residual psychotic and non-psychotic problems and home-based crisis management as in the modern ACT teams. Patients were included from 1992 to 1997. The catchment area was Sør-Trøndelag County with a population of about 250.000 inhabitants. At the time of inclusions, no effort was made to reduce the delay in seeking treatment in this region, but efforts were made to get referrals of all patients with recent onset psychotic disorder from psychiatric inpatient units, outpatient clinics, and general practitioners in the area. Patients who were clinically stable and were expected to reside in the county for at least 1 year after inclusion were asked to participate in the study. Patients with substance use disorders or mental retardation were excluded. The results after two years of treatment have been published in three papers.
Follow up: The follow up period was from the date of randomization and until 12 years after termination of treatment trial, 14 years forward. Data on duration of hospital admissions during these 14 years was extracted from the official Patient Administrative System, a standard system for clinical data in the health trust. Data was verified trough scrutiny and cross-checking of medical records.
Results: No differences in number of days in hospital, time to readmission, number of admittances to psychiatric wards, number of involuntarily psychiatric admissions or number of outpatient contacts over a period of 12 years following the initial 2-year treatment trial. Fewer patients in the IT group were involuntary admitted to hospital.
Study 2:
In Nidaros DPS, two of 17 beds at the rehabilitation section were converted into “self-referral to inpatient beds” reserved for patients with severe psychotic disorders who had earlier been admitted to the section. Patients in the “self-referral to inpatient beds” group signed a contract stating that they could administer their own admissions to the section, without referral from a doctor. The stay should be as short as possible; maximum 5 days, and there had to be a 14 days gap between admissions. The wait-list control group had admission procedures as usual. Participants in the wait-list control group were secured a contract on “patient guided psychiatric admission” one year after inclusion. Inclusion criteria were: Schizophrenia or bipolar disorder, 18 years or older, long term care and established relationship with the ward. Exclusion criteria were: Extensive substance use problems, self-destructive behavior or not being able to consent. The study was approved by The Regional Committee for Medical and Health Research Ethics in Central-Norway. From September 2010, 50 individuals were recruited and randomized.
Results: In December 2013, all patients are finished with their one year period in the study and all data are available primo January 2014.
Deltagere
- Vidir Sigrunarson Doktorgradsstipendiat
- Solveig Klæbo Reitan Medveileder, biveileder
- Inger Elise Opheim Moljord Forsker
- Lasse Eriksen Prosjektleder
- Rolf Wilhelm Gråwe Forsker
- Gunnar Morken Hovedveileder
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