Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
Orygen, Parkville, VIC, Australia.
Aust N Z J Psychiatry. 2022 Oct;56(10):1265-1276. doi: 10.1177/00048674211061285. Epub 2021 Nov 30.
Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported.
We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time.
Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment.
These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.
为首发精神病或超高精神病风险个体提供的服务已成为精神卫生保健的首选治疗模式。但现实世界治疗的临床和功能结果的纵向变化仍报道不足。
我们分析了澳大利亚初级青年心理健康服务机构中提供的首发精神病和超高风险服务的数据，该服务自 2017 年 6 月 19 日至 2019 年 9 月 30 日期间开展。参与者在接受治疗的每 90 天内完成并输入最小数据集，评估指标包括精神病症状（简明精神病评定量表和心理困扰，K10）和心理社会功能（社会和职业功能评定量表和我的生活轨迹）。线性混合效应模型用于评估随时间的变化。
共评估了 1252 名年轻人的结局数据（首发精神病 643 例，超高风险 609 例）。进入超高风险服务的患者中，11.8%转为首发精神病服务。总体而言，各组和结局的临床（简明精神病评定量表，K10）和功能（社会和职业功能评定量表，我的生活轨迹）结局均有明显改善。超高风险患者的症状困扰减轻程度更大，而首发精神病患者的阳性精神病症状减轻程度更大。虽然临床结局在护理约 3 个月后出现平台效应，但功能结局（社会和职业功能评定量表，我的生活轨迹）的改善在治疗后期仍在继续。
这些发现支持使用实时、真实世界和低成本的行政数据，在早期精神病治疗环境中严格评估症状和功能结局。功能结局在临床结局缓解后仍持续改善的发现也支持早期精神病服务的功能恢复重点，而持续高水平的困扰表明超高风险服务需要延长至 6 个月以上。
