Journal
CURRENT OPINION IN PSYCHIATRY
Volume 27, Issue 3, Pages 167-172Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/YCO.0000000000000052
Keywords
Assertive Community Treatment model; early intervention; first episode psychosis; randomized clinical trial; schizophrenia
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Funding
- Danish Ministry of Health [96-0770-71]
- Danish Ministry of Social Affairs
- University of Copenhagen
- Copenhagen Hospital Cooperation
- Danish Medical Research Council [9601612, 9900734]
- LundbeckFoundation
- TrygFoundation
- Capital Region of Denmark
- Mental Health Services in the Capital Region of Denmark
- Slagtermester Worzners Foundation
- Stanley Wada Research Foundation
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Purpose of reviewIt has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions.Recent findingsThe evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable.SummaryImplementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.
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