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Status of Patients With First-Episode Psychosis After One Year of Phase-Specific Community-Oriented Treatment

OBJECTIVE: A phase-specific intervention provided soon after the onset of a first episode of psychosis is likely to engender a more hopeful outlook. This article describes a community-oriented treatment program of phase-specific medical and psychosocial treatments integrated within an intensive case management model for patients with first-episode psychosis in a geographically defined population. One-year status is reported for a consecutive sample of patients with nonaffective mostly schizophrenic first-episode psychosis who were receiving treatment in this program. METHODS: Patients were assessed at baseline and at one year with a modified version of the Interview for Retrospective Assessment of Onset of Schizophrenia, the Structured Clinical Assessment for DSM-IV, the Scale for Assessment of Positive Symptoms, and the Scale for Assessment of Negative Symptoms to ascertain baseline patient characteristics, remission rates, hospital readmission rates, and change in the severity of symptoms. RESULTS: Data at 13 months for 53 patients indicated a complete remission rate of 70 percent, a hospital readmission rate of 20 percent, a highly significant improvement in all dimensions of psychopathology, higher rates of remission among patients who entered treatment within six months of the onset of psychosis (82 percent compared with 60 percent), and a longer median duration of untreated psychosis among patients who did not experience complete remission (10.5 compared with 6.5 months). Nearly half the patients received initial treatment as outpatients without adverse consequences for their subsequent use of hospitalization. CONCLUSIONS: An epidemiologically representative sample of patients experiencing a first episode of psychosis, when treated optimally with low dosages of novel antipsychotics and phase-specific psychological interventions, showed a high rate of clinical recovery and were able to remain in the community most of the time.

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