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Effectiveness of an Assertive Community Treatment program for people with severe schizophrenia in mainland China – a 12-month randomized controlled trial

Published online by Cambridge University Press:  02 July 2018

Xingwei Luo ,
Samuel F. Law ,
Xiang Wang Open the ORCID record for Xiang Wang [Opens in a new window] ,
Jingzheng Shi ,
Wu Zeng ,
Xiaoqian Ma ,
Wendy Chow ,
Shiyan Liu ,
Wei Zhao  and
Xiaoli Liu
...Show all authors
Xingwei Luo
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Samuel F. Law
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Xiang Wang*
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Jingzheng Shi
Affiliation:
Xiangya School of Public Health, Central South University, Changsha, Hunan410078, China
Wu Zeng
Affiliation:
Brandeis University, Waltham MA, 02454, USA
Xiaoqian Ma
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Wendy Chow
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Shiyan Liu
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Wei Zhao
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Xiaoli Liu
Affiliation:
Xiangya School of Public Health, Central South University, Changsha, Hunan410078, China
Shuqiao Yao
Affiliation:
Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
Michael R. Phillips
Affiliation:
Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China Departments of Psychiatry and Global Health, Emory University, Atlanta, GA, USA
*
Author for correspondence: Xiang Wang, E-mail: wang0916xia@gmail.com or wangxiang0916@csu.edu.cn
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Abstract

Background

Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China.

Methods

Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers.

Results

Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life.

Conclusion

Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted.

Keywords

Assertive Community Treatment (ACT)community mental health servicesfamily psychoeducationrandomized controlled trial (RCT)schizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 969 - 979
Copyright
Copyright © Cambridge University Press 2018 

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