Citation

Robinson DG, Schooler NR, Rosenheck RA, Lin H, Sint KJ, Marcy P, Kane JM. Psychiatr. Serv. 2019; 70(7): 569-577.

Affiliation

Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York (Schooler); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Rosenheck); Yale School of Public Health, New Haven (Lin, Sint); Vanguard Research Group, Glen Oaks, New York (Marcy).

Copyright

(Copyright © 2019, American Psychiatric Association)

DOI

10.1176/appi.ps.201800511

PMID

31084291

Abstract

OBJECTIVE: Despite treatment advances in other domains, inpatient psychiatric hospitalization rates for individuals with first-episode psychosis remain high. Even with early intervention services, a third or more of individuals are hospitalized over the first 2 years of treatment. Reducing hospitalization is desirable from the individual's perspective and for public health reasons because hospitalization costs are a major component of treatment costs.

METHODS: Univariate and multivariate baseline and time-varying covariate analyses were conducted to identify predictors of hospitalization in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 2-year cluster randomized trial for participants experiencing a first episode of psychosis who were outpatients at study entry. The trial compared an early intervention treatment model (NAVIGATE) with usual community care at 34 clinics across the United States.

RESULTS: RAISE-ETP enrolled 404 participants of whom 382 had one or more postbaseline assessments that included hospitalization data. Thirty-four percent of NAVIGATE and 37% of usual-care participants were hospitalized during the trial. Risk analyses revealed significant predictors of hospitalization to be the number of hospitalizations before study entry; duration of untreated psychosis; and time-varying days of substance misuse, presence of positive symptoms, and beliefs about the value of medication.

CONCLUSIONS: These results indicate that hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse, and facilitating adherence to medication taking. Addressing these factors could enhance the impact of first-episode early intervention treatment models and also enhance outcomes of people with first-episode psychosis treated using other models.

Language: en

Keywords

adherence; duration of untreated psychosis; first-episode psychosis; hospitalization; positive symptoms; substance misuse