RESUMO
OBJECTIVE: Assertive community treatment programmes are increasingly common worldwide but without much knowledge of their long-term effect. We investigated whether the implementation of such a programme would improve symptomatic and functional outcome 5 years later. METHODS: Naturalistic cohort study between 1995 and 2000 of all first-episode psychosis patients (n = 144) in Uppsala County, Sweden. We compared a 3-year period before (non-mACT) and after the introduction of a modified assertive community treatment (mACT) programme in 1998. Five-year outcome was assessed for symptoms and functioning and the two co-primary outcome measures were positive and negative symptoms. Regression models were adjusted for a propensity score based on multiple baseline variables and use of antipsychotics at 5-year follow-up. RESULTS: Contrary to our hypothesis, patients in the mACT group, compared to those in the non-mACT group, had a borderline significant increased risk of having a poor 5-year outcome regarding positive psychotic symptoms [adjusted odds ratio (OR) 3.21, 95% confidence interval (CI) 0.97-10.63]. There was no difference at the 5-year follow-up between the mACT and non-mACT group regarding negative symptoms (adjusted OR 1.65, 95% CI 0.48-5.66), or any of the secondary outcome measures: global assessment of functioning, hazardous alcohol use, use of illicit drugs, working or being in education, independent living, subjective satisfaction with life or suicide. Results were similar in subgroup analyses. CONCLUSIONS: The implementation of a modified assertive community treatment was not followed by subsequent improvements of 5-year outcome on a group level for patients with first-episode psychosis.
Assuntos
Serviços Comunitários de Saúde Mental/métodos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pontuação de Propensão , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/epidemiologia , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Suicídio/psicologia , Suécia/epidemiologia , Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: PECC (Psychosis Evaluation tool for Common use by Caregivers) is a recently developed tool for the longitudinal evaluation and follow-up of psychotic patients. This integrated evaluation tool covers different functional and symptomatic outcome measures, which are relevant for both the patient and the planning of interventions. PECC was especially designed to be easily implementable in the daily practice of nursing work. In this study we aimed to evaluate the inter-rater and interscale validity of PECC. RESULTS: The results indicate that both the inter-rater validity and the interscale validity of PECC are satisfactory. CONCLUSION: PECC can now be implemented on a large scale. (Int J Psych Clin Pract 2002; 6: 135-140).
