University of Melbourne, Victoria, Australia.
Centre for Youth Mental Health, University of Melbourne, Victoria, Australia; Orygen, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Schizophr Res. 2024 Oct;272:79-88. doi: 10.1016/j.schres.2024.08.013. Epub 2024 Aug 28.
In Australia, the first nationwide COVID-19 lockdown occurred in March 2020 bringing challenges for early intervention psychosis (EIP) services. Limited evidence exists on the impacts of the pandemic on treatment outcomes among EIP clients.
This prospective cohort study analysed routine data from 15 headspace Early Psychosis centres in Australia. Participants were 12 to 25 years, meeting criteria for First Episode Psychosis (FEP) or Ultra High Risk of psychosis (UHR) comparing those who commenced treatment 'pre-COVID-19' (between 16th August 2018 and 15th August 2019), and 'during-COVID-19' (between 1st March 2020 and 15th September 2020). Clinical symptoms at treatment commencement were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Kessler Psychological Distress Scale (K10). with outcomes after 6 months compared between cohorts using linear mixed-effects regression, controlling for confounders.
Of 1246 young people analysed (653 FEP, 596 UHR), significant improvements were observed with treatment in both groups (5 to 13-point reduction in BPRS score per 6-months treatment). Treatment effectiveness reduced during-COVID-19 for psychosis symptoms, with the FEP BPRS treatment effect lower by 4.3 points (95%CI: 0.5, 8.1). UHR clients had lower BPRS negative symptoms during-COVID-19 (p = 0.020). Service contacts increased during-COVID-19, with increased telehealth services (p < 0.001).
Early intervention remained effective for FEP and UHR, despite the pandemic and transition of EIP services to virtual service delivery. Reduced treatment efficacy in FEP psychosis symptoms may indicate potential limitations of telehealth. Further research to examine longer term clinical and functional outcomes due to the pandemic is required.
2020 年 3 月，澳大利亚实施了全国范围内的首次新冠疫情封锁，这给早期干预精神病学（EIP）服务带来了挑战。目前关于大流行对 EIP 患者治疗结果的影响的证据有限。
本前瞻性队列研究分析了澳大利亚 15 家 headspace 早期精神病中心的常规数据。参与者年龄在 12 至 25 岁之间，符合首次精神病发作（FEP）或精神病超高风险（UHR）标准，比较了那些在“新冠前”（2018 年 8 月 16 日至 2019 年 8 月 15 日）和“新冠期间”（2020 年 3 月 1 日至 2020 年 9 月 15 日）开始治疗的患者。使用简明精神病评定量表（BPRS）和 Kessler 心理困扰量表（K10）评估治疗开始时的临床症状，使用线性混合效应回归比较两组之间的 6 个月后的结果，同时控制混杂因素。
在分析的 1246 名年轻人中（653 名 FEP，596 名 UHR），两组患者在治疗中均有显著改善（每 6 个月治疗 BPRS 评分降低 5-13 分）。新冠期间，精神病症状的治疗效果下降，FEP 的 BPRS 治疗效果降低了 4.3 分（95%CI：0.5，8.1）。UHR 患者在新冠期间 BPRS 阴性症状较低（p=0.020）。新冠期间服务接触增加，远程医疗服务增加（p<0.001）。
尽管疫情爆发，EIP 服务向虚拟服务转变，但早期干预对 FEP 和 UHR 仍然有效。FEP 精神病症状的治疗效果降低可能表明远程医疗存在潜在局限性。需要进一步研究大流行导致的更长期的临床和功能结果。
