O11.5. EFFECTIVENESS OF COORDINATED SPECIALTY CARE FOR EARLY PSYCHOSIS

Abstract

Introduction.- Outcomes in people with schizophrenia-spectrum disorders have remained suboptimal. Several research programs for early psychosis yielded promising results for team-based, multielement coordinated specialty care (CSC). Objectives.- To meta-analytically compare CSC with Treatment as Usual (TAU). Methods.- Systematic literature search of PubMed/PsycInfo/Embase/clinicaltrials.gov without language restrictions until 06/06/2017 for randomized trials comparing CSC versus TAU in early psychosis. Random effects meta-analysis of>=2 studies with data, calculating standardized mean differences (SMDs) and risk ratios (RRs) for continuous and categorical outcomes. Results.- Across 10 trials (n = 2176; age = 27.5+/-4.6 years; male = 62.3%; trial duration = 16.2+/-7.4 (range = 9-24 months), CSC outperformed TAU at the end of treatment regarding all meta-analyzable outcomes. This included all-cause discontinuation (studies = 10, n = 2173, RR = 0.70, 95% confidence interval (CI)=0.61-0.80, P < 0.001; number-needed-to-treat (NNT) = 12.4),>=1 hospitalization (studies = 10, n = 2105, RR = 0.74, 95% CI = 0.61-0.90, P = 0.003; NNT= 10.1), total symptom severity (studies = 8, n = 1179, SMD=-0.32, 95% CI =-0.47, -0.17, P < 0.001), positive symptoms (studies = 10, n = 1532, SMD=-0.22, 95% CI =-0.32, -0.13, P < 0.001), negative symptoms (studies = 10, n = 1432, SMD=-0.28, 95% CI =-0.42, -0.14, P < 0.001), general symptoms (studies = 8, n = 1118, SMD=-0.30, 95% CI =-0.47, -0.13, P = 0.001), depressive symptoms (studies = 5, n = 874, SMD=-0.19, 95% CI =-0.35, -0.03, P = 0.017), functioning (studies = 7, n = 1005, SMD= 0.21, 95% CI = 0.09-0.34, P = 0.001), involvement in school/work (studies = 6, n = 1743, RR = 1.13, 95% CI = 1.03-1.24, P = 0.012; NNT= 17.8), and quality of life (studies = 4, n = 505, SMD= 0.23, 95% CI = 0.004-0.456, P = 0.046). Superiority of CSC regarding all outcomes was also evident at 6, 9-12, and 18-24 months of treatment (except general symptoms and depression at 18-24 months). Conclusion.- In early psychosis, CSC is superior to TAU across all meta-analyzable, highly relevant outcomes with small-to-medium effect sizes. These results support the need for funding and utilization of CSC in patients with early-phase psychosis.