Evaluation of a multi-element treatment center for early psychosis in the United States.

PURPOSE: A growing body of research has demonstrated the potential for comprehensive, phase-specific care to improve clinical and functional outcomes in early psychosis. However, there have been no evaluations of such treatment models in the United States (US). This study is a naturalistic, prospective 1-year follow-up of an early psychosis cohort treated in one of the first US-based multi-element treatment centers. METHODS: Participants were 163 individuals treated at the Outreach and Support Intervention Services (OASIS) clinic, a multi-element treatment center for early psychosis. Data were collected as part of routine care at 6-month intervals. Primary outcomes included role functioning and involvement in work or school. RESULTS: Over the course of 1 year of treatment, individuals experienced significant improvements in positive and negative symptoms, role functioning, and global functioning. The proportion of individuals meeting symptom remission and functional remission criteria increased significantly from baseline to 1 year, as did the proportion of individuals attending school. There were also trend-level reductions in substance abuse. CONCLUSIONS: This study provides preliminary support for the efficacy of comprehensive early intervention services in the US.

A preliminary trial of adherence-coping-education (ACE) therapy for early psychosis.

A pilot randomized controlled trial was conducted to examine the effectiveness of adherence-coping-education (ACE) therapy. Twenty-four individuals with early psychosis were randomized to receive 14 sessions of either ACE therapy in addition to treatment as usual, or supportive therapy in addition to treatment as usual. Participants were assessed at baseline, midtreatment, and posttreatment on measures of medication attitudes, psychotic and depressive symptoms, and social functioning. ACE therapy was well tolerated and was associated with significant decrease in symptoms, as well as trend-level improvements in attitudes toward treatment. These results lend initial support for the feasibility of ACE Therapy, and suggest that it may have promise in facilitating recovery for individuals recovering from an initial psychotic episode.

A pilot investigation of the Graduated Recovery Intervention Program (GRIP) for first episode psychosis.

The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.

Psychological well-being among individuals with first-episode psychosis.

AIM: Psychological well-being is a subjective component of quality of life (QOL) that has been previously unexplored in individuals recovering from an initial psychotic episode. This study examined predictors of psychological well-being among individuals with first-episode psychosis (FEP) and compared it to a non-clinical college-aged comparison group. METHODS: The Scales of Psychological Well-Being (SPWB) Environmental Mastery and Purpose in Life subscales were administered to both clinical (n = 41) and control (n = 39) participants. Clinical participants were also assessed on symptom measures and QOL, and all participants completed a measure of perceived social support. Multiple regression analyses were carried out to determine predictors of well-being in the FEP sample. RESULTS: SPWB scores were significantly lower for the FEP group in comparison to the control group. Additionally, greater perceived social support and lower levels of depression were found to be significant predictors of psychological well-being in the clinical sample, whereas gender and negative symptoms were not significant predictors. CONCLUSIONS: These results suggest that the development of a psychotic episode is associated with decreased subjective well-being, and that depression and social support may play an important role in this aspect of an individual's recovery. Additionally, the SPWB appear to be tapping into an important construct that has been relatively unexamined in first-episode research and may have potential utility in clinical practice and future treatment development.