The following is a summary of “Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals With First-Episode Schizophrenia Spectrum Disorder,” published in the February 2023 issue of Psychiatry by Hansen, et al.

The OPUS 20-year follow-up represents the longest follow-up of a clinical trial that evaluated early intervention services (EIS) for people with first-episode schizophrenia spectrum illness. For a multicenter randomized clinical trial, individuals with first-episode schizophrenia spectrum disorder were allocated to either an early intervention program group (OPUS) or treatment as usual (TAU). 

Between January 1998 and December 2000, the trial included a population-based sample of individuals aged 18 to 45 years who had not been treated with antipsychotics for >12 weeks before randomization and had no substance-induced psychosis, mental disability, or organic mental disorders. Researchers sought to report on the long-term associations of EIS compared with TAU for first-episode schizophrenia spectrum disorder. The study had a 20-year follow-up, the longest follow-up of a randomized clinical trial testing EIS. The analysis, conducted between December 2021 and August 2022, included measures such as psychopathological and functional outcomes, mortality, days of psychiatric hospitalizations, number of psychiatric outpatient contacts, use of supported housing/homeless shelters, symptom remission, and clinical recovery. In addition, EIS (OPUS) included 2 years of assertive community treatment that involved social skill training, psychoeducation, and family involvement by a multidisciplinary team, while TAU consisted of available community mental health treatment. The 20-year follow-up was carried out by raters blinded to the first treatment.

Of the 547 participants, 164 (30%) were interviewed during the 20-year follow-up period. The mean age was 45.9 (SD 5.6) years, and 85 (51.8%) were female. No significant differences were observed between the OPUS and TAU groups in terms of global functional levels (estimated mean difference, -3.72 [95% CI, -7.67 to 0.22]; P = .06), psychotic symptom dimensions (estimated mean difference, 0.14 [95% CI, -0.25 to 0.52]; P = .48), and negative symptom dimensions (estimated mean difference, 0.13 [95% CI, -0.18 to 0.44]; P = .41). The mortality rate was 13.1% (n = 36) in the OPUS group and 15.1% (n = 41) in the TAU group. In addition, there were no significant differences in the number of days of psychiatric hospitalizations (incidence rate ratio, 1.20 [95% CI, 0.73-1.20]; P = .46) or the number of outpatient contacts (incidence rate ratio, 1.20 [95% CI, 0.89-1.61]; P = .24) between the OPUS and TAU groups 10-20 years after randomization. Symptom remission was observed in 53 participants (40%) of the total sample, while clinical recovery was observed in 23 participants (18%).

There were no differences between 2 years of EIS vs. TAU among people with schizophrenia spectrum disorders diagnosed at the age of 20 were discovered in this randomized clinical trial follow-up investigation. New efforts were required to keep up the excellent work done over the first two years of the EIS and further enhance the long-term results. Even though there was no attrition in the registry data, a high attrition rate limits how clinical assessments can be interpreted. However, the lack of a long-term connection between OPUS and outcomes is most likely confirmed by the attrition bias.