Preventing Hospitalization as a Treatment Target for Interventions For Early Phase Schizophrenia

Learning Objectives:

1. Describe data on hospitalization rates by individuals with early phase psychosis;
2. Name factors associated with hospitalization by individuals with early phase psychosis; and
3. Describe the impact of long acting injectable antipsychotics on hospitalization rates by individuals
   with early phase psychosis.

Abstract:

Background: Even with current therapies, hospitalization rates for individuals with early phase psychosis remain high. To further development of interventions to reduce hospitalization, we report on predictors of hospitalization in the RAISE-ETP study and also the results of the Prelapse trial.

Methods: RAISE-ETP (34 sites) and Prelapse (39 sites) were cluster randomized trials. RAISE-ETP enrolled 404 individuals with first episode psychosis and compared NAVIGATE, an integrated treatment program, with usual care. Prelapse enrolled 489 individuals with recent onset schizophrenia and compared treatment with long-acting injectable (LAI) aripiprazole monohydrate with usual care over 2
years.

Results: Significant predictors of hospitalization during the first 2 years of RAISE-ETP were: the number of hospitalizations before study entry, duration of untreated psychosis, and time-varying days of substance misuse, presence of Positive and Negative Syndrome Scale positive symptoms, and beliefs about the value of medication. A survival analysis comparing treatment conditions on time to first
hospitalization in Prelapse revealed a hazard ratio of HR=0.56 (95% CI = 0.34, 0.92), p=0.02. The estimated probabilities of not having a hospitalization and 95% CIs were 0.73 (0.65, 0.83) for LAI participants and 0.58 (0.50, 0.67) for usual care participants. The number needed to treat for prevention of one hospitalization was 7 participants treated with LAI relative to usual care.

Conclusions: Hospitalization may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse and facilitating medication adherence. LAI antipsychotics can be effective at decreasing hospitalization risk with early phase patients.

Literature References:

1. Patients With Early-Phase Schizophrenia Will Accept Treatment With Sustained-Release Medication (Long-Acting Injectable Antipsychotics): Results From the Recruitment Phase of the PRELAPSE Trial.
   Kane JM, Schooler NR, Marcy P, Achtyes ED, Correll CU, Robinson DG. J Clin Psychiatry. 2019 Apr 23;80(3).
2. Predictors of Hospitalization of Individuals With First-Episode Psychosis: Data From a 2-Year Follow-Up of the RAISE-ETP. Robinson DG, Schooler NR, Rosenheck RA, Lin H, Sint KJ, Marcy P, Kane JM.
   Psychiatr Serv. 2019 Jul 1;70(7):569-577.
3. Focused Ethnographic Examination of Barriers to Use of Long-Acting Injectable Antipsychotics.
   Robinson DG, Subramaniam A, Fearis PJ, Shi R, Walsh M, Hanna LA, Kane JM. Psychiatr Serv. 2019 Dec 18 [Epub ahead of print]