Abstract
SummaryBackgroundProvision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery.MethodsWe did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16–35 years, had non-affective psychosis, had been clients of early intervention services for 12–30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571.FindingsBetween Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5–13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy.InterpretationOur findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so.FundingNational Institute for Health Research.
Highlights
Interpretation Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services
Potential participants were approached by their care coordinator and asked if they were willing to discuss the trial with a research assistant
Length of illness and duration of untreated psychosis were variable, but, as per the study inclusion criteria, all participants had been engaged with early intervention services for 12–30 months
Summary
Provision of early intervention services for first-episode psychosis has resulted in considerable gains in social functioning outcomes by comparison with traditional more generic mental health services. These services provide a range of interventions that aim to facilitate social recovery, including recovery-oriented intensive outreach case management. Before provision of early intervention services, as few as 15% of patients would make either partial or full social recovery at 2 years; this rate increased to between 40% and 60% after provision of these services.6,7a substantial proportion of individuals have continuing severe and persistent problems with social functioning, even after 12 months of provision of specialist early intervention services. People with poor responses to early intervention services often represent a subgroup who, presenting with first-episode psychosis, have chronic severe and complex mental health and social functioning problems that date back premorbidly to childhood. Problems associated with social recovery in people with first-episode psychosis are complex and include poor engagement with service. Provision of early intervention services for first-episode psychosis has resulted in considerable gains in social functioning outcomes by comparison with traditional more generic mental health services.. Provision of early intervention services for first-episode psychosis has resulted in considerable gains in social functioning outcomes by comparison with traditional more generic mental health services.1–3 These services provide a range of interventions that aim to facilitate social recovery, including recovery-oriented intensive outreach case management.. People with poor responses to early intervention services often represent a subgroup who, presenting with first-episode psychosis, have chronic severe and complex mental health and social functioning problems that date back premorbidly to childhood.. Problems associated with social recovery in people with first-episode psychosis are complex and include poor engagement with service
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