Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?

In this multicentre study the two-year outcome of two groups of consecutive patients (total N = 106) with first-episode functional non-affective psych osis, both treated according to the 'need-specific Finnish model', which st resses teamwork, patient and family participation and basic psychotherapeut ic attitudes, was compared. No alternative treatment facilities were availa ble in the study sites. The two study groups differed in the use of neurole ptics: three of the sites (the experimental group) used a minimal neurolept ic regime whilst the other three (the control group) used neuroleptics acco rding to the usual practice. Total time spent in hospital, occurrence of ps ychotic symptoms during the last follow-up year, employment, GAS score and the Grip on Life assessment were used as outcome measures. In the experimen tal group 42.9% of the patients did not receive neuroleptics at all during the whole two-year period, while the corresponding proportion in the contro l group was 5.9%. The overall outcome of the whole group could be seen as r ather favourable. The main result was that the outcome of the experimental group was equal or even somewhat better than that of the control group, als o after controlling for age. gender and diagnosis. This indicates that an i ntegrated approach, stressing intensive psychosocial measures, is recommend ed in the treatment of acute first-episode psychosis. (C) 2000 Editions sci entifiques et medicales Elsevier SAS.