Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial

Arch Gen Psychiatry. 2008 Jul;65(7):762-71. doi: 10.1001/archpsyc.65.7.762.


Context: Intensive early treatment for first-episode psychosis has been shown to be effective. It is unknown if the positive effects are sustained for 5 years.

Objective: To determine the long-term effects of an intensive early-intervention program (OPUS) for first-episode psychotic patients.

Design: Single-blinded, randomized, controlled clinical trial of 2 years of an intensive early-intervention program vs standard treatment. Follow-up periods were 2 and 5 years.

Setting: Copenhagen Hospital Corporation and Psychiatric Hospital, Aarhus, Denmark. Patients A total of 547 patients with a first episode of psychosis. Of these, 369 patients were participating in a 2-year follow-up, and 301 were participating in a 5-year follow-up. A total of 547 patients were followed for 5 years.

Interventions: Two years of an intensive early-intervention program vs standard treatment. The intensive early-intervention treatment consisted of assertive community treatment, family involvement, and social skills training. Standard treatment offered contact with a community mental health center.

Main outcome measures: Psychotic and negative symptoms were recorded. Secondary outcome measures were use of services and social functioning.

Results: Analysis was based on the principles of intention-to-treat. Assessment was blinded for previous treatment allocation. At the 5-year follow-up, the effect of treatment seen after 2 years (psychotic dimension odds ratio [OR], -0.32; 95% confidence interval [CI], -0.58 to -0.06; P = .02; negative dimension OR, -0.45; 95% CI, -0.67 to -0.22; P = .001) had equalized between the treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs 10%, respectively; OR, 2.3; 95% CI, 1.1-4.8; P = .02) and were hospitalized fewer days (mean, 149 vs 193 days; mean difference, 44 days; 95% CI, 0.15-88.12; P = .05) during the 5-year period.

Conclusions: The intensive early-intervention program improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years later. Secondary outcome measures showed differences in the proportion of patients living in supported housing and days in hospital at the 5-year follow-up in favor of the intensive early-intervention program.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms
  • Antipsychotic Agents / therapeutic use*
  • Assertiveness*
  • Community Mental Health Centers
  • Community Mental Health Services / statistics & numerical data*
  • Cost of Illness
  • Family Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • International Classification of Diseases
  • Male
  • Periodicity*
  • Problem Solving
  • Program Development*
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / therapy*
  • Secondary Prevention
  • Severity of Illness Index
  • Socialization*
  • Teaching / methods*
  • Time Factors


  • Antipsychotic Agents