BMJ  2004;329:1067 (6 November), doi:10.1136/bmj.38246.594873.7C (published 14 October 2004)

Paper

The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis

¹ Institute of Psychiatry, De Crespigny Park, London SE5 8AF, ² Lambeth Early Onset Service, South London and Maudsley NHS Trust, London SW9 9NT, ³ Biostatistics Group, School of Epidemiology and Health Science, University of Manchester, Manchester M13 9PT

Objective To evaluate the effectiveness of a service for early psychosis.

Design Randomised controlled clinical trial.

Setting Community mental health teams in one London borough.

Participants 144 people aged 16-40 years presenting to mental health services for the first or second time with non-organic, non-affective psychosis.

Interventions Assertive outreach with evidence based biopsychosocial interventions (specialised care group) and standard care (control group) delivered by community mental health teams.

Primary outcome measures Rates of relapse and readmission to hospital.

Results Compared with patients in the standard care group, those in the specialised care group were less likely to relapse (odds ratio 0.46, 95% confidence interval 0.22 to 0.97), were readmitted fewer times ( 0.39, 0.10 to 0.68), and were less likely to drop out of the study (odds ratio 0.35, 0.15 to 0.81). When rates were adjusted for sex, previous psychotic episode, and ethnicity, the difference in relapse was no longer significant (odds ratio 0.55, 0.24 to 1.26); only total number of readmissions ( 0.36, 0.04 to 0.66) and dropout rates ( 0.28, 0.12 to 0.73) remained significant.

Conclusions Limited evidence shows that a team delivering specialised care for patients with early psychosis is superior to standard care for maintaining contact with professionals and for reducing readmissions to hospital. No firm conclusions can, however, be drawn owing to the modest sample size.

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Rapid Responses:

Read all Rapid Responses

Comparing like with like?

Swaran P Singh
bmj.com, 22 Oct 2004 [Full text]

more detail in future

David H Yates
bmj.com, 1 Nov 2004 [Full text]

Paying attention is always good

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Authors ignore High EE homes & Non Compliance to treatment as possible causes for relapse and readmission?

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Re: Is this a randomised controlled trial?

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Audit of Three Year Outcomes in An Early Intervention Service

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