Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

Research output: Contribution to journalArticle

Authors

  • David Fowler
  • Jo Hodgekins
  • Paul French
  • Max Marshall
  • Nick Freemantle
  • Paul McCrone
  • Linda Everard
  • Peter B Jones
  • Tim Amos
  • Swaran Singh
  • Vimal Sharma
  • Max Birchwood

Colleges, School and Institutes

External organisations

  • Psychology Department, University of Sussex, Brighton, UK. Electronic address: d.fowler@sussex.ac.uk.
  • University of East Anglia
  • Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK; Institute of Health and Psychology, University of Liverpool, Liverpool, UK.
  • Lancashire Care NHS Foundation Trust, Preston, UK.
  • UNIVERSITY COLLEGE LONDON HOSPITALS
  • King's College London
  • Birmingham and Solihull Mental Health Foundation NHS Trust, UK
  • University of Cambridge
  • BRISTOL UNIVERSITY
  • University of Warwick, Coventry CV4 7AL, UK
  • University of Chester, Chester, UK; Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.

Abstract

BACKGROUND: Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery.

METHODS: We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16-35 years, had non-affective psychosis, had been clients of early intervention services for 12-30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571.

FINDINGS: Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5-13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy.

INTERPRETATION: Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so.

FUNDING: National Institute for Health Research.

Details

Original languageEnglish
Pages (from-to)41-50
Number of pages10
JournalThe Lancet Psychiatry
Volume5
Issue number1
Early online date11 Dec 2017
Publication statusPublished - Jan 2018

Keywords

  • Journal Article