Overall, 319 people presented to psychiatric services between January 2000 and October 2001 with symptoms suggestive of a psychotic disorder. Of these, 144 met the inclusion criteria and were randomised to receive either specialised care or standard care (). Data on number of relapses and readmissions to hospital were obtained for 136 (94%) patients over the 18 months of follow up. We had complete information on clinical status (recovered, unwell or relapsed) for 131 (91%) patients at 18 months.
Both groups were similar for most characteristics at baseline, although the specialised care group had fewer men, a higher proportion of first psychotic episodes, and a higher proportion of white people (). Patients in the specialised care group also had a longer duration of untreated psychosis, although the difference between the groups was not statistically significant (mean (SD) duration (months) of untreated psychosis: 10.5 (17.2) for specialised care v 7.6 (10.7) for controls).
Baseline characteristics of groups receiving specialised care or standard care for psychosis. Values are numbers (percentages) unless stated otherwise
For most patients, admission to hospital was their first experience of mental health care (43 of 71 patients (61%) in specialised care group, 44 of 73 patients (60%) in control group) two thirds of which were involuntary admissions (specialised care 67%, controls 72%).
At 18 months, one patient in the control group had died (unknown cause); 53 (86%) patients in the specialised care group and 44 (68%) patients in the control group were in regular contact with the clinical team (lost to care: odds ratio 0.35, 95% confidence interval 0.15 to 0.81). Patients in the specialised care group were offered more appointments during follow up than controls (mean (SD) number of appointments: 17.4 (9.1) for specialised care v 13.2 (8.7) for controls) and failed to attend a smaller proportion of the appointments (mean (SD) proportion of appointments missed: 0.12 (0.2) for specialised care v 0.33 (0.3) for controls). Seven patients in the specialised care group and 10 control patients were in hospital at the 18 months' follow up. One control patient was in prison.
Patients in the specialised care group were more likely than those in the control group to have been offered psychosocial interventions ().
Contact with mental health services and uptake of treatment over 18 months for patients receiving care for early psychosis. Values are numbers (percentages) of patients unless stated otherwise
Patients in the specialised care group were significantly more likely to be in recovery at follow up than patients in the control group; this included patients who had relapsed (). When only those patients who had not relapsed after initial recovery were classified as “well” (specialised care 64%, controls 48%), the difference between groups was attenuated and fell below statistical significance (odds ratio 0.52, 95% confidence interval 0.26 to 1.03).
Primary outcome measures for patients receiving specialised care or standard care for early psychosis. Values are numbers (percentages) of patients unless stated otherwise
Most patients in both groups recovered from the index episode (specialised care: full recovery 71%, partial recovery 19%; controls: full recovery 63%, partial recovery 28%). The average time to recovery was 5.5 (SD 4.0) months in both groups. Although there were no differences in these rates, patients in the specialised care group were less likely to relapse than those in the control group (specialised care 30% v controls 48%; P = 0.042). Patients in the specialised care group were also readmitted fewer times during follow up (see ).
Although the higher contact with services among patients in the specialised care group remained significant (lost to care: odds ratio 0.28; 95% confidence interval 0.12 to 0.73) when we adjusted for baseline differences in sex, previous psychotic episodes, and ethnic minority group, only the difference in total number of readmissions during follow up remained statistically significant (see ).