First-episode psychosis integrative treatment: Estonian experience

Abstract

Purpose

Research on first-episode psychosis early intervention has shown significant positive effects on psychopathological, functional and quality-of-life outcome measures. The effects reported have however been short-term and there is still only limited information about the long-term effects. This article will present the short-term results of an effectiveness study in a Baltic country and the first results of a registry-based long-term follow-up.

Methods

One hundred and ninety-nine first-episode psychosis patients were included in the early intervention effectiveness study in 2004–2008, and 107 were available for a follow-up after two years. Registry-based ten-year follow-up (n = 116) was conducted with a retrospectively formed control group (n = 114).

Results

Patients who received early intervention had substantial symptomatic improvement (BPRS score reduction > 50%) after 6 months of treatment, the Global Assessment of Functioning (GAF) scores were significantly improved after 6 months, and the quality of life after 12 months was significantly higher than at the beginning of treatment. After 2 years employment increased by 14% (43.9–57.9%). Long-term follow-up revealed that significantly fewer patients in the intervention group had been in supported housing compared to the control group. Patients in the intervention group had spent more time working during the follow-up period and had almost two times larger incomes, suggestive of higher employment/salary level.

Conclusions

Early intervention with flexible duration has positive long-term effects on the functioning of patients.

Keywords:

• First-episode psychosis
• early intervention
• long-term outcomes

Acknowledgments

The authors thank all the patients who participated in the study and the first-episode psychosis integrative treatment department of the North Estonia Medical Centre. We would also like to thank K. Küünarpuu, K. Troost, K. Orav, E. Eding, K. Aadamsoo, K. Eino, K. Konsap, M. Vonk, L. Hürden, K. Bunder and L. Tšerepanov who made the early assessment phase of the study possible. This study was initially part of an international research project ‘Multicenter Study of First Incident Psychosis’ (including 16 treatment facilities from Scandinavian and Baltic countries).

Disclosure statement

The authors declare no potential conflict of interest.

Figure 1. Flow of patients through the assessment phases of the study.

Additional information

Notes on contributors

Karola Peebo

Karola Peebo, MD, is a psychiatrist in the First-Episode Psychosis Integrative Treatment Department of the North Estonia Medical Centre.

Erika Saluveer

Erika Saluveer, MD, is a psychiatrist and Head of the First-episode Psychosis Integrative Treatment Department of the North Estonia Medical Centre.

Harri Küünarpuu

Harri Küünarpuu is a clinical psychologist in the First-Episode Psychosis Integrative Treatment Department of the North Estonia Medical Centre.

Teele Orgse

Teele Orgse, MD, is a healthcare quality specialist and worked as a Clinical Data Analyst in the North Estonia Medical Centre.

Jaanus Harro

Jaanus Harro, MD, PhD, is Professor and Chair, Neuropsychopharmacology, at the University of Tartu, and Research Associate at the Psychiatry Clinic, North Estonia Medical Centre.