Can we somehow identify people when they have their first episode of mental illness, surround them with a comprehensive array of therapies and support, and stave off development of frank schizophrenia? Yes, a study published in the American Journal of Psychiatry and that Rick and I discuss this week on PodMed concludes. Here's what they did: the study was called 'NAVIGATE,' and the approach utilized community-based care with four components: personalized medication management, family education about mental illness, individual therapy and employment or education. Just over 400 people were randomized to either this intervention or to usual care. They were followed for a minimum of two years.
Here's what they found: "The 223 recipients of NAVIGATE remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school compared with 181 participants in community care." Rick opines that while up front costs of this approach are undoubtedly higher than usual care, the long term benefits and likely reduction in costs relative to society would more than compensate for embracing this approach. Here's a fact both of us found startling: "The median duration of untreated psychosis was 74 weeks. " Wow. These folks were out there for over a year on average with untreated psychosis! Given the knowledge that early interventions work better, seems like the clear conclusion is to identify and enroll people as soon as possible.
Other topics this week include nicotinamide and skin cancers and outcomes of total knee replacement or not in NEJM, and use of medicines to manage cardiovascular risk worldwide in the Lancet. Until next week, y'all live well.