12-year follow-up of extended early intervention for first-episode psychosis in Hong Kong
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Key Takeaway
Interpret long-term psychosis recovery data from this Hong Kong RCT with caution due to attrition bias.
This study reports the 12-year follow-up of a randomized controlled trial conducted in Hong Kong. The trial originally compared a 1-year extension of specialized early intervention (3-year EI) to a 1-year step-down to standard care (2-year EI) in patients with first-episode psychosis who had completed a 2-year specialized early intervention service (EASY program). Of the initial cohort of 160 patients, 106 completed this long-term follow-up.
The primary outcome was not explicitly stated. Secondary outcomes included various recovery domains. At the 12-year follow-up, the reported rates were: symptomatic remission (SR) at 74.5%, functional recovery (FR) at 24.5%, personal recovery (PR) at 50.5%, clinical recovery (sustained SR and FR) at 22.6%, and full recovery (clinical recovery plus PR) at 16%. Extended EI was retained in prediction models for symptomatic remission and full recovery. The study did not report specific effect sizes, absolute numbers, or p-values for these comparisons.
Safety and tolerability data were not reported. Key limitations include significant attrition bias, as only 106 of the initial 160 patients were followed, and the observation that a sizeable proportion of patients remained functionally impaired. The authors explicitly note that findings regarding the potential effect of extended EI on long-term outcomes should be treated with caution. The study's relevance to practice is restrained; it suggests extended EI may be a factor in long-term symptomatic and full recovery models, but the high attrition and lack of robust comparative statistics limit definitive conclusions.
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View Original Abstract ↓
Remission and recovery are key treatment goals in psychotic disorders. This was a 12-year follow-up of a single-blind randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) (3-year EI) with 1-year step-down standard care (SC) (2-year EI) in patients who had completed 2-year specialized EI service (EASY program) in Hong-Kong. We systematically examined rates and predictors of symptomatic remission (SR), functional recovery (FR), personal recovery (PR), clinical recovery (fulfilled sustained SR and FR) and full recovery (fulfilled clinical recovery and PR) at 12-year follow-up. A comprehensive array of assessments was conducted encompassing premorbid adjustment and schizoid-schizotypal personality-traits (PSST), onset profiles, symptom dimensions, psychosocial functioning and treatment characteristics. LASSO-penalized and multivariate logistic-regression analyses were performed to construct prediction models of various remission/recovery outcomes. Correlational analyses exploring associations of PR with symptom and functional variables were conducted. A total of 106 of 160 of the initial patient cohort completed 12-year follow-up assessment. Rates of SR, FR, PR, clinical recovery and full recovery were 74.5, 24.5, 50.5, 22.6 and 16%, respectively. PSST and baseline functioning represented important predictors of FR and clinical recovery, while Extended EI was retained in prediction models for SR and full recovery. FR constituted a rate-limiting factor for clinical recovery and full recovery attainment. PR was negatively associated with negative and depressive symptoms, and positively related to psychosocial functioning. Our findings of potential effect of extended EI on long-term outcomes, however, should be treated with caution due to attrition bias, and a sizeable proportion of patients were functionally-impaired.
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