Robert Heinssen1; 1National Institute of Mental Health
The Recovery After an Initial Schizophrenia Episode initiative evaluated the feasibility, effectiveness, and scalability of a multi-element, team-based approach to first episode psychosis care in the United States. The Early Treatment Program comparative effectiveness trial (RAISE-ETP) enrolled 404 participants from 34 community centers in 21 states; clinics were randomly assigned to provide specialized early intervention services (NAVIGATE; N=17) or usual community care (N=17). The median duration of untreated psychosis (DUP) among participants was 74 weeks. After 24 months, NAVIGATE recipients experienced greater improvements in quality of life, psychopathology, and involvement in work or school compared with patients in community care. In addition, NAVIGATE was more cost-effective than typical treatment. Median DUP was a significant moderator of treatment effects on quality of life and overall symptoms, but not on employment or school attendance. Patients with shorter DUP derived substantially more benefit from NAVIGATE compared to those with longer DUP, and participants in community care. For NAVIGATE patients with DUP <74 weeks, average annual treatment costs were 15 percent lower compared to the annual cost of typical care. Together these findings underscore the importance of complementary approaches for improving FEP outcomes. In 2013, the National Institute of Mental Health launched research initiatives to test feasible strategies for reducing DUP and achieving rapid referral of persons with FEP to specialized treatment programs. The focus, methods, and preliminary findings from 10 funded projects will be presented, along with implications for reducing DUP in ~200 specialized early intervention clinics now established in the United States.
