Evaluation of a New Zealand Early Intervention Service for Psychosis

The effectiveness of a New Zealand early intervention for psychosis service (EIS) was assessed by analysis of 100 EIS patients' Positive and Negative Symptom Severity (PANNS) scores and Health of the Nation Outcome (HoNOS) scores that were collected over five time periods from intake through to 24 months. PANSS and HoNOS scores improved significantly within the first three months and continued to improve significantly over time. There was no significant relationship between duration of untreated psychosis and symptom severity or HoNOS scores either at intake or over time. Better outcomes were associated with length of contact with the service, high engagement and high medication compliance. Female patients had higher levels of engagement and medication compliance, and slightly better outcomes for negative symptoms. Level of satisfaction with the service was ascertained through small sub-samples of questionnaires and interviews. Patient satisfaction appeared to be associated with a collaborative therapeutic relationship rather than with treatment modality. It is recommended that future research seeks to clarify the specific skills necessary for establishing engagement, especially with male patients. ********** In the last decade there has been widespread development of early intervention services for psychosis, notably in Australia, Scandinavia, the UK and the USA (Birchwood, Fowler, & Jackson, 2000; Johannessen, 2004; Johannessen, Martindale, & Cullberg, 2006; MeGorry & Jackson, 1999). Currently in New Zealand there are approximately 20 early intervention services treating patients with first episode psychosis (Turner, Nightingale, Mulder, & Maginness, 2002). This widespread support for early intervention approaches has been influenced by the gradual change in the perception of schizophrenia from the traditional Kraepelinian view of schizophrenia as a degenerative and incurable disease to a more optimistic view. It is now more accepted that with effective interventions in a range of modalities the symptoms of psychosis and the overall wellbeing of the patient can significantly improve (Bentall, 2003; Cullberg, 2006; Martindale, Bateman, & Margison, 2000; Mosher, 1999; Read, Mosher, & Bentall, 2004). Additional support for early intervention comes from research showing that duration of untreated psychosis (DUP), estimated to average one to two years, is associated with a longer time to remission, a lesser degree of remission and an increased risk of relapse (Birchwood, Fowler, & Jackson, 2000; Birchwood & MacMillan, 1993; Gleeson, Larsen, & McGorry, 2003; Gleeson & McGorry, 2004; Johannessen, 2001, 2004; McGorry & Jackson, 1999; Turner et al., 2002). Early intervention services have the following aims: 1) reduce the duration of untreated psychosis; 2) provide comprehensive effective treatment of the first episode of psychosis; 3) reduce the duration of active psychosis in the first episode; 4) prevent or alleviate subsequent relapse; and 5) maximise recovery, community involvement and quality of life (McGorry & Jackson, 1999). There is, however, great diversity in the type of models and treatments used in early intervention services to achieve these aims including: residential homes, psychotherapy, cognitive therapy, neuroleptic medications, relapse prevention strategies, family therapy, and psycho-education. It is common for services to offer various combinations of these approaches, rather than adhering to one method of intervention. The widespread use and diversity of early intervention services requires investigation and research in order to be able to constitute what makes appropriate and effective care. This study aimed to evaluate the effectiveness of a New Zealand early intervention for psychosis service (EIS) in treating patients presenting for the first time with psychotic experiences. This research defines psychosis as the first experience of symptoms of schizophrenia as defined in the Diagnostic Statistical Manual of Mental Disorders fourth edition (DSM-IV). …