Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T04:18:38.355Z Has data issue: false hasContentIssue false
  • English
  • Français

Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?

Published online by Cambridge University Press:  16 April 2020

V. Lehtinen ,
J. Aaltonen ,
T. Koffert ,
V. Räkköläinen  and
E. Syvälahti
V. Lehtinen*
Affiliation:
Mental Health R&D Group, the National Research and Development Centre for Welfare and Health, STAKES, Mestarinkatu 2 D, FIN-20810Turku, Finland
J. Aaltonen
Affiliation:
Department of Psychology, University of Jyväskylä,Jyväskylä, Finland
T. Koffert
Affiliation:
Mental Health R&D Group, the National Research and Development Centre for Welfare and Health, STAKES, Mestarinkatu 2 D, FIN-20810Turku, Finland
V. Räkköläinen
Affiliation:
Kupittaa Hospital,Turku, Finland
E. Syvälahti
Affiliation:
Department of Pharmacology and Clinical Pharmacology, University of Turku,Turku, Finland
*
*Correspondence and reprints
Get access

Summary

In this multicentre study the two-year outcome of two groups of consecutive patients (total N = 106) with first-episode functional non-affective psychosis, both treated according to the ‘need-specific Finnish model’, which stresses teamwork, patient and family participation and basic psychotherapeutic attitudes, was compared. No alternative treatment facilities were available in the study sites. The two study groups differed in the use of neuroleptics: three of the sites (the experimental group) used a minimal neuroleptic regime whilst the other three (the control group) used neuroleptics according to the usual practice. Total time spent in hospital, occurrence of psychotic symptoms during the last follow-up year, employment, GAS score and the Grip on Life assessment were used as outcome measures. In the experimental group 42.9% of the patients did not receive neuroleptics at all during the whole two-year period, while the corresponding proportion in the control group was 5.9%. The overall outcome of the whole group could be seen as rather favourable. The main result was that the outcome of the experimental group was equal or even somewhat better than that of the control group, also after controlling for age, gender and diagnosis. This indicates that an integrated approach, stressing intensive psychosocial measures, is recommended in the treatment of acute first-episode psychosis.

Keywords

first-time psychosisfollow-up studyintegrated treatmentoutcomeuse of neuroleptics
Type
Original Article
Information
European Psychiatry , Volume 15 , Issue 5 , August 2000 , pp. 312 - 320
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaltonen, J.Perhekeskeisen hoitoprosessin lähtökohdat psykiatrisessa hoidossa. (English summary: The starting points of the family-centred treatment process in psychiatric open care) 1982 Annales Universitatis Turkuensis TurkuGoogle Scholar
Alanen, Y.O.Schizophrenia. Its origins and need-adapted treatment 1997 Karnac Books LondonGoogle Scholar
Alanen, Y.O.Anttinen, E.E.Kokkola, A.Lehtinen, K.Ojanen, M.Pylkkänen, K. et al. Treatment and rehabilitation of schizophrenic psychoses. The Finnish treatment model Nord J Psychiatry 44 Suppl 22 1990 1–65Google Scholar
Alanen, Y.O.Lehtinen, V.Lehtinen, K.Aaltonen, J.Räkköläinen, V.The Finnish integrated model for early treatment of schizophrenia and related psychosesMartindale, BBateman, ACrowe, MMargison, FPsychosis. Psychological approaches and their effectiveness 1999 Gaskell London235–265Google Scholar
Alanen, Y.O.Räkköläinen, V.Laakso, J.Rasimus, R.Kaljonen, A.Towards need-specific treatment of schizophrenic psychoses 1986 Springer-Verlag HeidelbergCrossRefGoogle ScholarPubMed
American Psychiatric Association. Practice guidelines for the treatment of patients with schizophrenia Am J Psychiatry 154 Suppl 1997 1–21CrossRefGoogle Scholar
Åsberg, M.Montgomery, S.A.Perris, C.Scalling, D.Sedvall, G.A comprehensive psychological rating scale Acta Psychiatr Scand 69 Suppl 271 1978 5–28CrossRefGoogle Scholar
Carpenter, W.T.The risk of medication-free research Schizophr Bull 23 1997 11–18CrossRefGoogle ScholarPubMed
Carpenter, W.T.Hanlon, T.E.Heinrichs, D.W.Summerfelt, A.T.Kirkpatrick, B.Levine, J. et al. Continuous versus targeted medication in schizophrenic outpatients: outcome results Am J Psychiatry 147 1990 1138–1148Google ScholarPubMed
Carpenter, W.T.McGlashan, T.H.Strauss, J.S.The treatment of acute schizophrenia without drugs: an investigation of some current assumptions Am J Psychiatry 134 1977 14–20Google ScholarPubMed
Carpenter, W.T.Schooler, N.R.Kane, J.M.The rationale and ethics of medication-free research in schizophrenia Arch Gen Psychiatry 54 1997 401–407CrossRefGoogle Scholar
Ciompi, L.Dauwalder, H.P.Maier, C.Aebi, E.Das Pilotprojekt “Soteria Bern” zur Behandlung akut Schizophrener. I. Konzeptuelle Grundlagen, praktische Realisierung, klinische Erfahrungen Nervenarzt 62 1991 428–435Google Scholar
Davis, J.M.Casper, R.Antipsychotic drugs: clinical pharmacology and therapeutic use Drugs 14 1977 260–282CrossRefGoogle ScholarPubMed
Endicott, J.Spitzer, R.L.Fleiss, J.L.Cohen, J.The Global Assessment Scale – a procedure for measuring overall severity of psychiatric disturbance Arch Gen Psychiatry 33 1976 766–771CrossRefGoogle ScholarPubMed
Kane, J.M.Marder, S.R.Psychopharmacologic treatment of schizophrenia Schizophr Bull 19 1993 287–302CrossRefGoogle ScholarPubMed
Konsensus-rapport. Skizofreni 1992 Statens Sundhedsvidenskabelige Forskningsråd KöbenhavnGoogle Scholar
Lehman, A.F.Steinwachs, D.M. et al. At issue: translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations Schizophr Bull 24 1998 1–10CrossRefGoogle Scholar
Lehtinen, V.Aaltonen, J.Koffert, T.Räkköläinen, V.Syvälahti, E.Integrated treatment model for first-contact patients with a schizophrenia-type psychosis: the Finnish API project Nord J Psychiatry 50 1996 281–287CrossRefGoogle Scholar
Lehtinen, V.Panelius, M.Tienari, P.Finnish consensus development conference on the treatment of schizophrenia Int J Technol Assess Health Care 5 1989 269–281CrossRefGoogle ScholarPubMed
Matthews, S.M.Roper, M.T.Mosher, L.R.Menn, A.Z.A non-neuroleptic treatment for schizophrenia: analysis of the two-year post-discharge risk of relapse Schizophr Bull 5 1979 322–333CrossRefGoogle Scholar
McEvoy, J.P.Hogarty, G.E.Steingard, S.Optimal dose neuroleptic in acute schizophrenia. A controlled study of the neuroleptic threshold and higher haloperidol dose Arch Gen Psychiatry 48 1991 739–745CrossRefGoogle ScholarPubMed
Olson, D.Russell, C.Sprenkle, D.Circumplex model of marital and family systems. VI. Theoretical update Family Process 2 1983 69–83CrossRefGoogle Scholar
Overall, J.E.Gorham, D.R.The brief psychiatric rating scale Psychol Rep 10 1962 799–812CrossRefGoogle Scholar
Penn, D.L.Mueser, K.T.Research update on the psychosocial treatment of schizophrenia Am J Psychiatry 153 1996 607–617Google ScholarPubMed
Ram, R.Bromet, E.J.Eaton, W.W.Pato, C.Schwartz, J.E.The natural course of schizophrenia: a review of first-admission studies Schizophr Bull 18 1992 185–207CrossRefGoogle ScholarPubMed
Rappaport, M.Hopkins, H.K.Hall, K.Bellaza, T.Silverman, J.Are there schizophrenics for whom drugs may be unnecessary or contraindicated? Int Pharmacopsychiatry 13 1978 100–111CrossRefGoogle ScholarPubMed
Salokangas, R.K.R.Räkköläinen, V.Alanen, Y.O.Maintenance of grip on life and goals of life: a valuable criterion for evaluating outcome in schizophrenia Acta Psychiatr Scand 80 1989 187–193CrossRefGoogle Scholar
Schooler, R.Goldberg, S.C.Boothe, H.Cole, J.O.One year after discharge: community adjustment of schizophrenic patients Am J Psychiatry 123 1967 986–995CrossRefGoogle ScholarPubMed
Wyatt, R.J.Neuroleptics and the natural course of schizophrenia Schizophr Bull 17 1991 325–351CrossRefGoogle ScholarPubMed
Wyatt, R.J.Risks of withdrawing antipsychotic medications Arch Gen Psychiatry 52 1995 205–208CrossRefGoogle ScholarPubMed
Wyatt, R.J.Research in schizophrenia and the discontinuation of antipsychotic medications Schizophr Bull 23 1997 3–9CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.