Transcript The ”Parachute project” for first episode psychosis

Toronto, June 6, 2008
Johan Cullberg MD PhD
Ersta Sköndal University College, Stockholm
Principles for ”need adapted treatment”
of first episode psychosis in Parachute project
1. Early intervention (< 24 hours)
2. Therapeutic alliance and early crisis orientation
3. Family meetings (< 24 hours)
4. Continuity and easy accessibility during 5 years
5. Minimal effective neuroleptic treatment. Initial sleep-promoting
treatment. Bz when needed.
6. Optimal in-patient milieu (personal, low stimulus, noninstitutional)
7. Early rehabilitation
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Every first episode psychotic patient from 17 clinics
(appr 1.5 million inhabitants)
Fullfilling criteria (incl non-congr. aff.ps) (SCID)
253
Incidence/100.000 18-45 years
24.5
Dropout (31%) more non-sz
78
Research population
5-year follow-up
175
154
Prospective comparison group 3 years
64
Historic comparison group (TAU) 5 years
72
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Small scale (3-6 beds)
Non-institutional and personal setting
Non-invasive but empathic and stable staff
No high demands for common activities
Unlocked doors daytime
No chronic patients
Access to emergency ward when needed
Support from mobile psychosis team
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Outcome: clinics with crisis home vs. only
psychiatric ward
Mean GAF- values, schizophrenic syndromes
70
60
50
40
With Crisis home
Only ps. ward
30
20
10
0
Baseline
1 year - p< 0,05
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“Recovered”
On antipsychotic med.
Depot: 3 pats out of 69
Median dose (halop.eqv)
Sick pension or sick leave
Suicide
In institution
54 %
48 %
4%
2 mg
32 %
1%
5%
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Direct cost per patient with revised baseline
diagnosis of schizophrenia (€)
(Year 1 p= .05, years 1-3 p= .08)
30000
25000
20000
Year 1
Year 2
Year 3
15000
10000
5000
0
Parachute
Prospective control
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%
35
30
25
20
Outcome group at
5 yrs %
15
10
5
0
+
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The 7 ”need specific” principles are feasible
and cost-effective with a large scale
organisation
Effects better than TAU
There is no rational reason to hesitate in
developing specific FEP care in all
psychiatric clinics
Psychological and medical treatments must
be individualised. There is no general rule
how to treat a FEP patient!
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