A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

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Abstract
Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness. Clinical outcomes and user satisfaction of patients with a first episode of psychotic illness who received integrated treatment or standard treatment. Values are means (SD) unless stated otherwise Design Randomised clinical trial. Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, Denmark. Participants 547 patients with first episode of schizophrenia spectrum disorder. Interventions Integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training. Standard treatment offered contact with a community mental health centre. Main outcome measures Psychotic and negative symptoms (each scored from 0 to a maximum of 5) at one and two years' follow-up. Results At one year's follow-up, psychotic symptoms changed favourably to a mean of 1.09 (standard deviation 1.27) with an estimated mean difference between groups of −0.31 (95% confidence interval −0.55 to −0.07, P = 0.02) in favour of integrated treatment. Negative symptoms changed favourably with an estimated difference between groups of −0.36 (−0.54 to −0.17, P < 0.001) in favour of integrated treatment. At two years' follow-up the estimated mean difference between groups in psychotic symptoms was −0.32 (−0.58 to −0.06, P = 0.02) and in negative symptoms was −0.45 (−0.67 to −0.22, P < 0.001), both in favour of integrated treatment. Patients who received integrated treatment had significantly less comorbid substance misuse, better adherence to treatment, and more satisfaction with treatment. Conclusion Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent at one year and two year follow-ups.