NAVIGATING the Management of First-Episode Psychosis

Schizophrenia treatments have increasingly focused on early detection and intervention in an effort to reduce impairment and chronicity. In this National Institute of Mental Health (NIMH)–funded study randomized by clinic, investigators assigned 404 individuals with first-episode schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychosis not otherwise specified to ≥2 years of treatment in NAVIGATE — a coordinated specialty-care program involving personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment and education — or to usual community care and treatment.

Participants (mean age at baseline, 23; median duration of untreated psychosis, 74 weeks; 71% living with their families) were seen at 34 community mental health centers in 21 states. The NAVIGATE group had more males, fewer school attenders, fewer who had been hospitalized, and worse Positive and Negative Syndrome Scale (PANSS) scores. NAVIGATE treatments were provided by local staff who received additional training and monitoring.

Compared with the control group, NAVIGATE patients received more key services and remained in treatment significantly longer (median, 23 vs. 17 months). Overall, NAVIGATE patients showed significantly greater clinically meaningful improvements in quality of life (QOL), interpersonal relationships, intrapsychic foundations (sense of purpose, motivation, curiosity, emotional engagement), and work and school attendance. Hospitalization rates during the 2-year follow-up did not differ between groups (NAVIGATE, 34%; community care, 37%). Patients initially untreated for <74 weeks showed greater improvements in QOL and PANSS scores than those untreated for ≥74 weeks (effect sizes, 0.54 vs. 0.07 for QOL; 0.42 vs. 0.13 for PANSS).