Abstract
The UK700 trial failed to demonstrate an overall benefit of intensive case management (ICM) in patients with severe psychotic illness. This does not discount a benefit for particular subgroups, and evidence of a benefit of ICM for patients of borderline intelligence has been presented. The aim of this study is to investigate whether this effect is part of a general benefit for patients with severe psychosis complicated by additional needs. In the UK700 trial patients with severe psychosis were randomly allocated to ICM or standard case management. For each patient group with complex needs the effect of ICM is compared with that in the rest of the study cohort. Outcome measures are days spent in psychiatric hospital and the admission and discharge rates. ICM may be of benefit to patients with severe psychosis complicated by borderline intelligence or depression, but may cause patients using illicit drugs to spend more time in hospital. There was no convincing evidence of an effect of ICM in a further seven patient groups. ICM is not of general benefit to patients with severe psychosis complicated by additional needs. The benefit of ICM for patients with borderline intelligence is an isolated effect which should be interpreted cautiously until further data are available.
Similar content being viewed by others
References
UK700 Group (1999) Comparison of intensive and standard case management for patients with psychosis. Rationale of the trial. Br J Psychiatry 174:74–78
Burns T, Creed F, Fahy T, Thompson S, Tyrer P, White I (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. The UK700 Group. Lancet 353:2185–2189
Tyrer P, Hassiotis A, Ukoumunne O, Piachaud J, Harvey K (1999) Intensive case management for psychotic patients with borderline intelligence. The UK700 Group. Lancet 354:999–1000
Hassiotis A, Ukoumunne OC, Byford S, Tyrer P, Harvey K, Piachaud J, Gilvarry K, Fraser J (2001) Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management. Report from the UK700 trial. Br J Psychiatry 178:166–171
McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770
Jablensky A, Schwartz R, Tomov T (1980) WHO collaborative study of impairments and disabilities associated with schizophrenic disorders: a preliminary communication—objectives and methods. Acta Psychiatr Scand 62:152–163
Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P, Barnes T, Bench C, Middleton H, Wright N, Paterson S, Shanahan W, Seivewright N, Ford C (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry 183:304–313
Metcalfe C, Thompson SG, White IR (2005) Analyzing the duration of recurrent events in clinical trials: a comparison of approaches using data from the UK700 trial of psychiatric case management. Contemp Clin Trials 26:443–458
Carpenter J, Bithell J (2000) Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med 19:1141–1164
Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236
StataCorp (2003) Stata statistical software: release 8.0. Stata, College Station, TX
Kirkwood BR, Sterne JAC (2003) Essential medical statistics, 2nd edn. Blackwell, Oxford
Andersen PK, Rasmussen NK (1986) Psychiatric admissions and choice of abortion. Stat Med 5:243–253
Cox DR (1972) Regression models and life tables. J R Stat Soc Ser B Stat Methodol 34:187–220
Mahé C, Chevret S (2001) Analysis of recurrent failure times data: should the baseline hazard be stratified? Stat Med 20:3807–3815
Cox DR (1975) Partial likelihood. Biometrika 62:269–276
Weaver T, Tyrer P, Ritchie J, Renton A (2003) Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial. Br J Psychiatry 183:437–445
Acknowledgements
Chris Metcalfe wrote this paper whilst funded as a UK National Health Service and Medical Research Council Fellow in Health Services Research and whilst in receipt of a Raymond and Beverley Sackler Studentship from the University of Cambridge. Professors Tom Burns, Francis Creed, and Peter Tyrer coordinated the UK700 study at the centres from which data were obtained for the present study. All three provided useful comments on earlier drafts of this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Metcalfe, C., White, I.R., Weaver, T. et al. Intensive case management for severe psychotic illness: is there a general benefit for patients with complex needs?. Soc Psychiat Epidemiol 40, 718–724 (2005). https://doi.org/10.1007/s00127-005-0954-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-005-0954-6