O4.5. LONG TERM EFFECTS OF EARLY INTERVENTION SERVICES FOR FIRST EPISODE PSYCHOSIS: OUTCOMES OVER FIVE YEARS FROM THE RECOVERY AFTER A 1ST EPISODE OF SCHIZOPHRENIA-EARLY TREATMENT PROGRAM (RAISE-ETP)

BACKGROUND: Early intervention services (EIS) for first episode psychosis (FEP) are now implemented worldwide and these integrated and team-based treatment programs improve FEP outcomes while patients are participating. EIS service and treatment models provide care for limited periods followed by return to standard services. Cross sectional follow-up studies conducted after EIS participation ends have not been able to find advantages compared with standard care. The RAISE-ETP study was the first US-based, multi-center randomized clinical trial to compare an EIS, labeled NAVIGATE, to usual clinical care. Those who received NAVIGATE experienced significant improvement in symptoms and functioning compared to those who received usual care during the initial two-year treatment period. We now report clinical outcomes covering five years, a time frame that includes care after EIS participation ended. METHODS: RAISE-ETP was a cluster randomized clinical trial conducted at 34 US sites; 17 sites provided NAVIGATE to 223 participants and 17 sites provided usual clinical care to 181 participants. NAVIGATE was available until the last randomized subject had the opportunity for two years of services. Participants were assessed every six months for up to 60 months by masked, centralized assessors utilizing live two-way video and with the Heinrichs-Carpenter Quality of Life Scale (QLS) and the Positive and Negative Syndrome Scale (PANSS). RESULTS: Participants had a mean age of 23 years and the majority were male; (78% in NAVIGATE and 66% in usual care). The mean opportunity for NAVIGATE treatment was 33.8 (SD=5.1) months; the longest 44.4 months. Compared with usual care, NAVIGATE over 5 years was associated with a 13.14 unit QLS (p<0.001) and 7.73 unit PANSS (p<0.002) better improvement and 2.5 fewer inpatient days (p=0.02). NAVIGATE opportunity length did not affect QLS outcome; duration of untreated psychosis did not moderate differential QLS outcome. DISCUSSION: RAISE-ETP provides compelling evidence of a substantial long-term benefit for FEP treatment with the NAVIGATE EIS compared with standard care.