Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland.
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Switzerland; Service of community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland.
Psychiatry Res. 2016 May 30;239:212-9. doi: 10.1016/j.psychres.2016.03.010. Epub 2016 Mar 5.
Most specialized Early Psychosis (EP) programs include assertive outreach (AO) principles, either for all patients or as an intensive case management (ICM) subprogram in selected situations. The objective of this study is to examine prevalence, characteristics and outcomes of patients who needed additional ICM in a specialized EP program.
In a 3-year prospective naturalistic study of 229 consecutive EP patients treated at TIPP-Lausanne we compared characteristics of those who needed ICM and those who did not.
60 (26.2%) TIPP patients needed ICM. At baseline, ICM-patients showed a poorer academic premorbid functioning (p=0.019); lower level of insight (p<0.001); had a previous history of alcohol (p=0.043) and cannabis (p=0.040) use. ICM-patients were less likely to be adherent to medication during the early phase of treatment but differences disappeared during follow-up. ICM-patients showed globally a poorer functional level and higher level of positive and negative symptoms during the follow-up.
About one quarter of EP patients needed a combination of ICM and assertive outreach. Despite the high treatment adherence in both groups, psychotic symptoms remained higher in ICM-patients. In a real live setting with limited resources, combination of ICM and AO in selected situations seems a valid solution.
大多数专门的早期精神病（EP）项目都包含了坚定的外展（AO）原则，无论是针对所有患者，还是在特定情况下作为强化病例管理（ICM）的子项目。本研究的目的是研究专门的 EP 项目中需要额外 ICM 的患者的患病率、特征和结果。
在对 229 例连续接受 TIPP-Lausanne 治疗的 EP 患者进行的为期 3 年的前瞻性自然主义研究中，我们比较了需要 ICM 和不需要 ICM 的患者的特征。
229 例患者中有 60 例（26.2%）需要 ICM。在基线时，ICM 患者表现出较差的学业前期功能（p=0.019）；较低的洞察力（p<0.001）；有酒精（p=0.043）和大麻（p=0.040）使用的既往史。ICM 患者在治疗的早期阶段更不可能遵守药物治疗，但在随访期间差异消失。ICM 患者在随访期间表现出整体较差的功能水平和更高的阳性和阴性症状水平。
大约四分之一的 EP 患者需要 ICM 和坚定的外展相结合。尽管两组患者的治疗依从性都很高，但 ICM 患者的精神病症状仍然较高。在资源有限的实际环境中，在特定情况下结合 ICM 和 AO 似乎是一种有效的解决方案。
