Stage-specific Case Management for Early Psychosis

NCT ID: NCT00919620

Last Updated: 2020-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

360 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-06-30

Study Completion Date

2015-12-31

Brief Summary

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One of the commonly adopted strategies in improving outcome in psychotic disorders is by focused, specific and intensive intervention in the initial few years of the disorder. However the effects of intervention and the optimal duration of intervention have seldom been examined in randomized studies. This study uses a randomized controlled study design to investigate the effectiveness of stage-specific case-management in improving outcome of first episode psychotic disorders. It also addresses whether two years of case-management is less effective than four years of case-management over a four year period. A total of 360 subjects, who aged 25 above, and diagnosed with first episode psychotic disorders, will be and randomized into 3 groups: (1) standard care alone without case management, (2) two-year case management, (3) four-year case management. All groups will receive usual standard care treatment. This four-year follow-up study will assess symptoms, functioning, quality of life as well as health economics data.

Detailed Description

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Psychotic disorder is a debilitating illness which imposes substantial impact to the patients, their families, and the society. The provision of early intervention provides a window of opportunity to minimize the social and economic burden incurred by the illness.

Many previous studies of effectiveness of early intervention used the historical control approach and are subjected to cohort effects. For example, change of medication pattern over time could potentially lead to differences in outcome. In addition, few studies provide longer-term outcome data of treatment program beyond two years. The optimal length of intervention has not been determined, and many programmes used 12-24 month intervention mainly based on resources available. It is also important to ask whether favorable effects of early intervention could be sustained over time. Further analyses will be done to assess whether EI effects are more pronounced in particular subgroups including DUP, age, sex and diagnosis.

The proposed study aims to address these issues by using a randomized controlled design to investigate the longer-term (4 year) outcome of patients with first episode psychosis. The study randomizes 360 patients with first episode psychotic disorders into 3 groups: (1) standard care (outpatient based care with inpatient and community care as required); (2) standard care with 2 years of add-on stage specific case-management (individualized care delivered by designated case managers according to specific protocol); and (3) standard care with 4 years of add-on stage specific case management.

The study hypothesis are: (1) both 2 years and 4 years of case management produce better outcomes than standard care alone; (2) 4 years of case management produces better outcome than 2 years of case management.

Conditions

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Psychotic Disorders

Keywords

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Psychotic disorders Psychoses

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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case management (4 yrs)

4-year case management and standard care

Group Type EXPERIMENTAL

stage-specific case-management

Intervention Type BEHAVIORAL

Stage-specific case-management for psychosis by designated key-workers according to specified protocol

case management (2 yrs) and standard care (2 yrs)

2-year case management and standard care

Group Type ACTIVE_COMPARATOR

stage-specific case-management

Intervention Type BEHAVIORAL

Stage-specific case-management for psychosis by designated key-workers according to specified protocol

standard care (4 yrs)

standard care for 4 years

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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stage-specific case-management

Stage-specific case-management for psychosis by designated key-workers according to specified protocol

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* DSM-IV diagnosis of schizophrenia, schizoaffective disorder, schizophreniform psychosis, brief psychosis, psychosis nos or delusional disorder
* Cantonese-speaking Chinese
* Ability to understand the nature of the study and sign informed consent
* Capacity to participate in cognitive testing

Exclusion Criteria

* Organic Brain disorder
* Known history of intellectual disability
Minimum Eligible Age

26 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Queen Mary Hospital, Hong Kong

OTHER

Sponsor Role collaborator

Kwai Chung Hospital

OTHER

Sponsor Role collaborator

Kowloon Hospital, Hong Kong

OTHER

Sponsor Role collaborator

Castle Peak Hospital

OTHER_GOV

Sponsor Role collaborator

Shatin Hospital

OTHER

Sponsor Role collaborator

Tai Po Hospital

OTHER_GOV

Sponsor Role collaborator

North District Hospital, Hong Kong

UNKNOWN

Sponsor Role collaborator

United Christian Hospital

OTHER

Sponsor Role collaborator

Queen Elizabeth Hospital, Hong Kong

OTHER

Sponsor Role collaborator

The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Professor Eric Y.H. Chen

Professor and Head of Department of Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Eric YH Chen, MD

Role: PRINCIPAL_INVESTIGATOR

The University of Hong Kong

Locations

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The University of Hong Kong

Hong Kong, , China

Site Status

Countries

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China

References

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Hui CLM, Wong AKH, Ho ECN, Lam BST, Hui PWM, Tao TJ, Chang WC, Chan SKW, Lee EHM, Suen YN, Lam MML, Chiu CPY, Li FWS, Leung KF, McGhee SM, Law CW, Chung DWS, Yeung WS, Yiu MGC, Pang EPF, Tso S, Lui SSY, Hung SF, Lee WK, Yip KC, Kwan KL, Ng RMK, Sham PC, Honer WG, Chen EYH. Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial. Psychol Med. 2023 Apr;53(6):2339-2351. doi: 10.1017/S0033291721004189. Epub 2022 Feb 11.

Reference Type DERIVED
PMID: 35144700 (View on PubMed)

Puntis S, Minichino A, De Crescenzo F, Cipriani A, Lennox B, Harrison R. Specialised early intervention teams for recent-onset psychosis. Cochrane Database Syst Rev. 2020 Nov 2;11(11):CD013288. doi: 10.1002/14651858.CD013288.pub2.

Reference Type DERIVED
PMID: 33135811 (View on PubMed)

Other Identifiers

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jcep-rct

Identifier Type: -

Identifier Source: org_study_id