The ”Parachute project” for first episode psychosis

1. The ”Parachute project” for first episode psychosis Toronto, June 6, 2008 Johan Cullberg MD PhD Ersta Sköndal University College, Stockholm

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3. Parachute project - Material Every first episodepsychotic patient from 17 clinics(appr 1.5 million inhabitants) Fullfillingcriteria (inclnon-congr. aff.ps) (SCID) 253 Incidence/100.000 18-45 years24.5 Dropout (31%) morenon-sz78 Research population 175 5-year follow-up 154 Prospectivecomparison group 3 years 64 Historiccomparison group (TAU) 5 years 72 jc

4. A functional f.e. psychosis over-night care milieu: • 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 jc

5. 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 jc

6. 5 year outcome – total Parachute group N=153 • “Recovered” 54 % • On antipsychotic med. 48 % • Depot: 3 pats out of 69 4 % • Median dose (halop.eqv) 2 mg • Sick pension or sick leave 32 % • Suicide 1 % • In institution 5 % jc

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8. Outcome level 5 years after first episode psychosis N=153 % jc

9. Conclusions • 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! jc