Adaptation and Assessment of Efficacy of Early Intervention Programme for Patients with Schizophrenia Spectrum First-Episode Psychosis in Latgale Region. Summary of the Doctoral Thesis

Abstract

Adaptation and Assesment of Efficacy of Early Intervention Program for Patients with Schizophrenia Spectrum First-Episode Psychosis in Latgale Region Introduction. Schizophrenia spectrum disorders are one of the most common psychiatric disorders, with a course that can lead to chronic illness with potentially lost ability to work and reduced independence. Strategies to not only reduce symptoms of schizophrenia but also to renew the functional capacity of patients with the first episode of schizophrenic spectrum psychosis by promoting professional and social functioning are researched and reviewed in practise. Evidence in literature (Correll, 2018) points to the importance of early intervention in the treatment of schizophrenia spectrum psychotic disorders, however proposals to successfully adapt and introduce the method in everyday psychiatric practice are still needed. Aims. Adapt into clinical practise an early intervention programme for patients with the first episode of schizophrenia spectrum psychosis, evaluate the effectiveness of the programme on clinical and functional parameters compared to standard treatment during a 12-month period after the first episode of schizophrenic spectrum psychosis. Materials and methods. A prospective quasi-experimental cohort study with a control group, without randomization was performed. Of the 137 recruited patients, that were admitted to the Daugavpils psychoneurological hospital (DPNH) between January 1st 2016 and December 31st 2018 with the first episode of schizophrenic spectrum psychosis (FEP) 112 met the inclusion criteria, 14 patients refused to participate in the study, and another 35 patients were excluded from the study due to a multitude of reasons from either group, with 88 patients being included in the final data analysis. Participants of the study underwent a clinical interview that included the assessment for positive and negative symptoms of schizophrenia (SAPS, SANS), assessment of symptoms of depression (Calgary scale for depression, CSDD), Schedule of assessment of insight expanded version (SAI–E) and assessment of global functioning (GAF). All patients included in the study were treated in the DPNH acute psychosis ward, receiving treatment following unified principles outlined in clinical guidelines. After discharge from the hospital patients in the control group (n = 61) received standard treatment (ST) according to their will, and patients in the intervention group (n = 27) were offered a 6- month long treatment plan in the Latvian early intervention programme (LAT–EIP). Patients’ sociodemographic data and psychopathological symptoms were assessed on enrolment in the study. After a 12-month follow-up period form the start of treatment of FEP clinical (including status of remission) and functional (professional and social functioning) parameters were compared, as well as doctor’s appointments, use of medication, repeated admissions, and assignment of disability. Additionally, the proportion of refusal to continue participation in LAT–EIP and the attendance was assessed. The following descriptive and analytic methods were used in the final statistical data processing. The Pearson’s chi-squared test or Fisher’s exact test were used for the comparison of independent categorical variables, additionally, Cramér’s V value was used to assess size of effect, and the McNemar’s test for the comparison of dependant groups. Normally distributed quantitative parameters were evaluated using the independent t-test, using Cohen’s d coefficient to assess effect size, otherwise using the Mann–Whitney test or Wilcoxon test. To find and evaluate associations between parameters, univariate and multivariate weighted logistic regression was used, with results expressed as odds ratios with a 95 % confidence interval. Results. 52.5 % (n = 32) of the control group were men, and 85.2 % (n = 23) of the intervention group were men, p = 0.007. The median age of patients was 32 years (Q1–Q3: 27.0–39.0), and in the intervention group (n = 27) it was 29.0 years (Q1–Q3: 24.0–32.0), p = 0.042. Family history of psychiatric illness, suicide attempts, and years in education were not statistically different between groups. No statistical difference between groups was found in psychopathological positive and negative symptoms of schizophrenia and depression symptoms both at the time of admission with FEP and at discharge from hospital. After the 12- month follow-up period, during which patients in the control group received standard treatment (ST) and patients in the intervention group received LAT–EIP, intervention group’s patients had less pronounced positive and negative symptoms of schizophrenia, and higher global functioning levels. On enrolment in the study there were no statistical differences in employment, after the follow-up period, however, 63.0 % (n = 10) of patients in the intervention group were employed, and 31.1 % (n = 19) in the control group, p = 0.01. No differences in living arrangements were detected both on enrolment and after the 12-month follow-up period. The number of readmissions during the 12-month follow-up was significantly different, patients of the control group were 4.41 (95 % CI 1.56–12.45, p < 0,05) times more likely (OR) to be readmitted than patients in the intervention group. The number of total visits with a psychiatrist did not differ between groups, however, only one visit or not visits at all with an out-patient psychiatrist was 6.25 times (OR) (95 % CI 1.11–10.0, p = 0,04) more likely in the controle group, and discontinuation of medication against medical advice was 6.35 times (OR) (95 % CI 1.60–46.50; p < 0.01) more frequent in the control group when compared to patients in the intervention group. Remission was achieved 3.51 (95 % CI 1.33–10.2; p = 0.019) times more often in the intervention group, compared to patients receiving standard treatment. Conclusions. Results of the study partially confirm the proposed hypotheses. After 12 months patients with the first episode of schizophrenic spectrum psychosis that received treatment in the early intervention programme had less pronounced positive and negative symptoms, higher levels of professional functioning, fewer readmissions, and fewer instances of assigned disability compared to patients receiving standard treatment, however no differences related to treatment in living conditions or social domain were found. The early intervention programme is suitable for implementation in the Latvian psychiatric healthcare for the treatment of patients with schizophrenia spectrum disorders. Early intervention provides a continuation of treatment when transitioning from inpatient to outpatient treatment, patients in the intervention group visited the outpatient care psychiatrist at least once after discharge from the hospital at a higher rate, were less likely to discontinue medications against medical advice. Patients who received early intervention achieved remission more frequently as patients in the controle group. The results of this study are comparable to others available in literature, and the conclusions permit to be optimistic for the betterment of treatment of schizophrenia spectrum disorders in Latvia. This doctoral thesis can be looked at as the first step in the further development and progress of the intervention programme in the Daugavpils psychoneurological hospital and its introduction in psychiatric outpatient care in other psychiatric hospitals of Latvia.