Conditions: Schizophrenia and Disorders With Psychotic Features
Keywords: First episode psychosis Specialized care Phase-specific treatment Schizophrenia Disorders with psychotic features
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 120
Healthy volunteers: no

Brief summary:
The purpose of this study is to understand the effectiveness of a specialized package of phase-specific treatments for individuals in the midst of their first episode of psychosis. The pharmacologic and psychosocial treatments will be delivered within a state public mental health center.

Detailed description:
We propose to conduct a clinical trial for first episode psychosis patients not eligible for CMHC services that will compare randomized access to care at CMHC versus the usual procedure of referral to community providers outside CMHC. Patients randomized to access to CMHC services will receive multifaceted, intensive, phase-specific care delivered by a specialized clinical team. This care will include five principal components: antipsychotic prescription, multi-family group therapy, group cognitive behavioral therapy, cognitive remediation and individual case management including supportive, problem solving approaches and a focus on resumption of movement towards educational and/or employment related goals. All consenting subjects will undergo research evaluations every six months for up to five years. Outcomes will be assessed in the domains of re-admission (primary outcome), relapse, symptoms, overall functioning, quality of life, education and employment, treatment satisfaction, adherence, substance use, adverse events (including self-harm) and economic measures including service use, cost of care and forensic data.

Arms:
arm 1: Referral to community providers. arm 2: Integrated and comprehensive treatment provided by a specialized team in a public mental health center.Interventions include pharmacotherapy, family education, cognitive behavioral group and individual psychotherapy and case management focused on vocational rehabilitation.

Interventions: intervention 1: Cognitive Behavioral Group Therapy intervention 2: Cognitive remediation intervention 3: Medications intervention 4: MFG intervention 5: Assertive case management intervention 6: Treatment as Usual in the community
Intervention descriptions: intervention 1: once per week intervention 2: as needed intervention 3: Individualized prescription of psychotropic medications including but not restricted to antipsychotic, antidepressant and mood stabilizers. intervention 4: Multi-Family psychoeducation Group based on the model published by McFarlane et al. intervention 5: Meetings with an individual clinician (social work or nursing) who provides supportive psychotherapy, helps assist with vocational and educational supports. intervention 6: Subjects randomized to this arm either return to their existing outpatient psychiatrist or, if they do not have one yet, are referred by the clinic to preferred providers in the community. The nature of the interventions provided is variable and is being monitored by the research clinic.

Protocol document: