Duration of Untreated Psychosis Critical in RAISE Success

Results from the National Institute of Mental Health (NIMH) Recovery After an Initial Schizophrenia Episode (RAISE) study show that a coordinated specialty care model can be implemented in a diverse range of community clinics and that the quality of life for first-episode patients can be improved.

But how long a patient with psychosis has gone untreated is a critical factor in whether patients can benefit from that model, John Kane, M.D., a program director of RAISE, said Saturday during a session at APA’s 2015 annual meeting on reducing the duration of untreated psychosis.

As part of the RAISE project, patients at 34 participating clinics were randomly assigned to a special psychosocial intervention known as NAVIGATE or to usual community care. NAVIGATE emphasizes shared decision making (among providers, patients, and family members), a focus on strength and resiliency, psychoeducational teaching skills, motivational enhancement teaching skills, and collaboration with the patient’s natural support system. There are four essential components of NAVIGATE—psychopharmacology, individual resiliency training, family psychoeducation, and supported employment or education.

“Recipients of NAVIGATE were significantly more likely to remain in treatment and experienced significantly greater improvement in the primary outcome measure of quality of life,” Kane said. “They were more likely to be working or going to school, and NAVIGATE participants showed a significantly greater degree of symptom improvement on the PANSS [Positive and Negative Symptom Scale] and the CDSS [Calgary Depression Scale for Schizophrenia].”

But those patients who had a longer duration of untreated psychosis before entering the program were also significantly less likely to benefit—underscoring the vital importance of efforts to reduce the duration of untreated psychosis (DUP).

Kane said the average DUP for patients with schizophrenia in the United States is seven years, a figure that must be reduced significantly to improve long-term outcome for patients. He noted that in addition to the RAISE program, NIMH had also initiated efforts to reduce DUP. Such efforts include anonymous e-surveys of high school and college students with links to psychoeducational websites and referral to specialty care, interviews with early phase patients and families to understand pathways to care, and social media to disseminate education about psychosis.

Kane was joined at the session by Oliver Freudenrich, M.D., of Harvard University, who spoke about high-quality psychiatric care to reduce time of active psychosis; Brian O’Donoghue, M.D., of the University of Melbourne, who spoke about the reduction of DUP in Australia and Ireland; and Robert Zipursky, M.D., of McMaster University, who talked about the relationship of DUP to recovery.