Intended for healthcare professionals


A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

BMJ 2005; 331 doi: (Published 15 September 2005) Cite this as: BMJ 2005;331:602

This article has a correction. Please see:

  1. Lone Petersen, research fellow1,
  2. Pia Jeppesen, research fellow2,
  3. Anne Thorup, research fellow2,
  4. Maj-Britt Abel, research fellow2,
  5. Johan Øhlenschlæger, research fellow3,
  6. Torben Østergaard Christensen, research fellow4,
  7. Gertrud Krarup, chief psychiatrist4,
  8. Per Jørgensen, medical director4,
  9. Merete Nordentoft (merete.nordentoft{at}, associate professor1
  1. 1 Bispebjerg Hospital, Department of Psychiatry, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark; and Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
  2. 2 Bispebjerg Hospital, Department of Psychiatry, Copenhagen NV, Denmark
  3. 3 Sct Hans Hospital, DK-4000 Roskilde, Denmark
  4. 4 Psychiatric Hospital Risskov, Skovagervej 2, DK-8240 Risskov, Denmark
  1. Correspondence to: M Nordentoft
  • Accepted 19 July 2005


Objectives To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness.

Table 2

Clinical outcomes and user satisfaction of patients with a first episode of psychotic illness who received integrated treatment or standard treatment. Values are means (SD) unless stated otherwise

View this table:

Design Randomised clinical trial.

Setting Copenhagen Hospital Corporation and Psychiatric Hospital Aarhus, Denmark.

Participants 547 patients with first episode of schizophrenia spectrum disorder.

Interventions Integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family involvement and social skills training. Standard treatment offered contact with a community mental health centre.

Main outcome measures Psychotic and negative symptoms (each scored from 0 to a maximum of 5) at one and two years' follow-up.

Results At one year's follow-up, psychotic symptoms changed favourably to a mean of 1.09 (standard deviation 1.27) with an estimated mean difference between groups of −0.31 (95% confidence interval −0.55 to −0.07, P = 0.02) in favour of integrated treatment. Negative symptoms changed favourably with an estimated difference between groups of −0.36 (−0.54 to −0.17, P < 0.001) in favour of integrated treatment. At two years' follow-up the estimated mean difference between groups in psychotic symptoms was −0.32 (−0.58 to −0.06, P = 0.02) and in negative symptoms was −0.45 (−0.67 to −0.22, P < 0.001), both in favour of integrated treatment. Patients who received integrated treatment had significantly less comorbid substance misuse, better adherence to treatment, and more satisfaction with treatment.

Conclusion Integrated treatment improved clinical outcome and adherence to treatment. The improvement in clinical outcome was consistent at one year and two year follow-ups.


  • Contributors Professors Ralf Hemmingsen and Niels Reisbyt participated in designing the study and writing the initial application for funds. Profes-sor Philip Hougaard supervised the statistical analyses. Runa Munkner and Per Kassow conducted research interviews. The staff at the Copenhagen Trial Unit planned and conducted the randomisation procedure for the Copenhagen patients. All the authors participated in critical revision of drafts for the manuscript and approved the final version. MN and PeJ were responsible for designing the study and, together with PiJ and MA, chose the assessment instruments. PiJ, MA, PeJ, LP, AT, JØ, TØC, and GK conducted the research interviews. MN, LP, AT, and PiJ analysed the data, and LP and MN wrote and revised the manuscript. MN is guarantor for the study.

  • Funding The project received grants from the Danish Ministry of Health ( 96-0770-71), Danish Ministry of Social Affairs, University of Copenhagen, Copenhagen Hospital Corporation, Danish Medical Research Council ( 9601612 and 9900734), and Slagtermester Wørzners Foundation.

  • Competing interests None declared.

  • Ethical approval The local ethics committee approved the trial (KF 01-387/97).

  • Amendment This is Version 2 of the paper. LP's and MN's affiliation to the Copenhagen Trial Unit has been added, and table 2 has been corrected (the denominator for the standard treatment group at 1 year follow-up changed from 193 to 192).

  • Accepted 19 July 2005
View Full Text