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Power P, Elkins K, Adlard S, Curry C, McGorry P, and Harrigan S (1998).

British Journal of Psychiatry 172 (Suppl 33): 71-76.

IMPORTANCE FOR EARLY INTERVENTION

The results of the EPPIC are one of the first "real world" or naturalistic studies of early intervention, in which principles thought to apply to the detection and prevention of the earliest episodes of psychosis are actually used as part of a treatment plan. The sample size in this study was reasonably large, and patients were followed for three months. Results from the EPPIC study seem to indicate that early detection and intervention may reduce both the number and duration of hospitalizations, that a high number of patients (80 percent) responded to treatment, and that low-dose medication management appeared to be an effective way to treat these illnesses.

SUMMARY

Most studies of first-episode psychosis have involved hospitalized patients. Studies suggest, however, that treatment should begin as early as possible for first-episode patients because, with optimal treatment, recovery from the first episode of psychosis can be remarkably good. In this article, the authors describe the Early Psychosis Prevention and Intervention Center (EPPIC), in Melbourne, Australia. The goal of the EPPIC is to manage first-episode psychosis, with an emphasis on early detection, the use of low-dose antipsychotic medications, a less restrictive environment, and psychological intervention, including a strong social support system. The aim of this study was to present findings from a naturalistic or ‘real world’ assessment of the initial treatment phase in early psychosis rather than construe inferences from review studies or trials in hospitalized patients.

Data were examined from the first three months of treatment for 231 consecutive admissions with first-episode psychosis. All patients were between the ages of 16 and 30 and presented with symptoms of first-episode psychosis (eg, hallucinations, delusions, disorganized behavior and/or formal thought disorder). Diagnoses included both affective and non-affective psychosis. Clinical ratings were assessed through the Brief Psychiatric Rating Scale (BPRS), the Health of the Nation Outcome Scale (HoNOS), and the Scale for Assessment of Negative Symptoms (SANS). Ratings were obtained immediately following entry to treatment, as well as at the time of remission of active positive symptoms or at three months, whichever occurred first.

The authors found that about one third of those treated did not require hospitalization. Hospitalizations for the remaining patients were brief, and most (68 percent) occurred within the first day of contact with the EPPIC. Only 16 percent required a second hospitalization, and only four percent required a third hospitalization within the three-month evaluation period; second and third admissions were shorter than the first. Individuals with bipolar disorder were more likely to be hospitalized. Individuals who were hospitalized received higher doses of antipsychotic medications, but they also had a greater rate of reduction on the BPRS.

Hospitalized patients had higher mean HoNOS aggression scores, as well as higher BPRS excitement scores than non-hospitalized patients, although these higher ratings may reflect the fact that more individuals with bipolar disorder were hospitalized. By the end of the three-month period, 80 percent of the sample had responded to treatment, and 63 percent were in remission. Little change was observed in negative symptom scores. The results of this study suggest that both hospitalized and non-hospitalized people with first-episode psychosis can be managed with low-dose antipsychotic medications and experience significant reductions in their symptom ratings within the first three months of treatment.

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