Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants

被引：94

作者：

Ruggeri, Mirella ^{[1
,2
]}

Bonetto, Chiara ^{[1
]}

Lasalvia, Antonio ^{[1
,2
]}

Fioritti, Angelo ^{[3
]}

de Girolamo, Giovanni ^{[4
,8
]}

Santonastaso, Paolo ^{[5
,6
]}

Pileggi, Francesca ^{[3
]}

Neri, Giovanni ^{[7
]}

Ghigi, Daniela ^{[9
]}

Giubilini, Franco ^{[10
]}

Miceli, Maurizio ^{[11
]}

Scarone, Silvio ^{[12
]}

Cocchi, Angelo ^{[13
]}

Torresani, Stefano ^{[14
]}

Faravelli, Carlo ^{[15
]}

Cremonese, Carla ^{[16
]}

Scocco, Paolo ^{[17
]}

Leuci, Emanuela ^{[10
]}

Mazzi, Fausto ^{[18
]}

Pratelli, Michela ^{[9
]}

Bellini, Francesca ^{[9
]}

Tosato, Sarah ^{[1
,2
]}

De Santi, Katia ^{[1
,2
]}

Bissoli, Sarah ^{[1
]}

Poli, Sara ^{[1
]}

Ira, Elisa ^{[1
]}

Zoppei, Silvia ^{[1
]}

Rucci, Paola ^{[3
,8
]}

Bislenghi, Laura ^{[13
]}

Patelli, Giovanni ^{[13
]}

Cristofalo, Doriana ^{[1
]}

Meneghelli, Anna ^{[13
]}

机构：

[1] Univ Verona, Dept Publ Hlth & Community Med, Policlin GB Rossi, Sect Psychiat, I-37134 Verona, Italy

[2] Azienda Osped Univ Integrata Verona, Verona, Italy

[3] Azienda ULSS Bologna, Dept Mental Hlth, Bologna, Italy

[4] St John God Clin Res Ctr Brescia, Sci Direct, Brescia, Lombardia, Italy

[5] Univ Padua, Dept Neurosci, Padua, Italy

[6] Azienda Osped Padova, Padua, Italy

[7] Azienda ULSS Modena, Dept Mental Hlth, Modena, Italy

[8] Agenzia Sanitaria & Sociale Reg, Reggio Emilia, Regione Emilia, Italy

[9] Dept Mental Hlth, Rimini, Italy

[10] Dept Mental Hlth, Parma, Italy

[11] Dept Mental Hlth, Florence, Italy

[12] Univ Milan, Dept Psychiat, Milan, Italy

[13] AO Osped Niguarda Ca Granda Milano, MHD Programma 2000, Milan, Italy

[14] Dept Mental Hlth, Bolzano, Italy

[15] Univ Florence, Dept Psychiat, Florence, Italy

[16] Azienda Osped Padova, Dept Mental Hlth, Padua, Italy

[17] Azienda ULSS 16, Dept Mental Hlth, Padua, Italy

[18] Dept Mental Hlth, Modena, Italy

来源：

SCHIZOPHRENIA BULLETIN | 2015年 / 41卷 / 05期

关键词：

schizophrenia; early psychosis; outcome assessment; cognitive behavioral therapy; family intervention; COGNITIVE-BEHAVIORAL THERAPY; FAMILY INTERVENTION; FOLLOW-UP; COMMUNITY PSYCHIATRY; STANDARD TREATMENT; MULTICENTER TRIAL; SPECIALIZED CARE; 1ST EPISODE; SCHIZOPHRENIA; SYMPTOMS;

D O I：

10.1093/schbul/sbv058

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemio-logically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.

引用

页码：1192 / 1203

页数：12

共 67 条

[1] International clinical practice guidelines for early psychosis [J].

Addington, J ;

Amminger, GP ;

Barbato, A ;

Catts, S ;

Chen, E ;

Chhim, S ;

Chong, SA ;

Cullberg, J ;

Edwards, J ;

Grosso, L ;

Louza, M ;

Hambrecht, M ;

Keshavan, M ;

Johannessen, JO ;

Johnson, DL ;

Lewis, S ;

Lieberman, J ;

MacEwan, W ;

Malla, A ;

May, R ;

McGlashan, TH ;

McGorry, P ;

Merlo, MG ;

Nordentoft, M ;

Nightingale, S ;

Perkins, D ;

Thara, R ;

Yamamoto, K ;

Yung, A .

BRITISH JOURNAL OF PSYCHIATRY, 2005, 187 :S120-S124

[2]

[Anonymous], 2011, ADV PSYCHIAT TREATME

[3]

[Anonymous], 2005, AUSTR NZ J PSYCHI S2

[4]

[Anonymous], PSYCHIAT B

[5]

[Anonymous], GLI INT PREC NELL SC

[6]

[Anonymous], PRACT GUID TREATM PA

[7]

[Anonymous], 1992, SCHED CLIN ASS NEUR

[8]

[Anonymous], J MENTAL HLTH

[9]

[Anonymous], 2009, Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care

[10]

[Anonymous], 2001, MENT HLTH POL IMPL G

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