Journal List > J Korean Neuropsychiatr Assoc > v.52(4) > 1017634

Lee, Ahn, Son, Kim, Park, and Cho: A Study on the Effectiveness of Community-Based Case Management Program for the First Episode Psychosis



The purpose of this study was to make empirical evidence for a community based case management program for the first episode of psychosis.


We provided a case management program for first episode psychosis patients and assessed their symptoms, function, insight, and satisfaction using Positive and Negative Syndrome Scale (PANSS), the Health of Nation Outcomes Scales (HoNOS), Scale to assess Unawareness of Mental Disorder (SUMD), Global Assessment of Functioning Scales (GAF), and Quality of Life scales (QOL) at baseline and after the program. We also evaluated the treatment maintenance rate and the changes of their developmental task achievement.


Significant improvement was observed in all sub-domains of PANSS and significant changes were also observed in the areas of symptoms and function of HoNOS. Significant improvement was observed in awareness of mental illness itself and its outcomes. The treatment maintenance rate was 87.5%, including three patients who stopped their medication with the doctor's order. The rate of participation in meaningful social activities, such as school or job showed an increase, from 25% at baseline to 81% after the program.


Results of this study demonstrate the possibility of community programs for prevention of relapse, improvement of symptoms and function, and facilitation of return to meaningful social activities of first episode psychosis patients.

Figures and Tables

Fig. 1
PANSS: Positive and Negative Syndrome Scale, HoNOS: Health of the Nation Outcomes Scales, SUMD: Scale to Assess Unawareness of Mental Disorder, GAF: Global Assessment of Functioning Scales.
Fig. 2
The contents and process of STEP program. STEP: Social Treatment for Early Psychosis.
Table 1
General characteristics of the subjects
Table 2
Psychiatric characteristics of the subjects

DUP: Duration of Untreated Psychosis

Table 3
Pre-post comparison by assessment tools

PANSS: Positive and Negative Syndrome Scale, HoNOS: Health of the Nation Outcomes Scales, SUMD: Scale to Assess Unawareness of Mental Disorder, GAF: Global Assessment of Functioning Scales, QOL: Quality of Life

Table 4
The education and job status changes after intervention


The authors have no financial conflicts of interest.


1. Birchwood M, Macmillan F. Early intervention in schizophrenia. Aust N Z J Psychiatry. 1993. 27:374–378.
2. Brichwood M. Birchwood M, Fowler D, Jackson C, editors. The critical period for early intervention in psychosis. Early Intervention in psychosis: A Guide to Concepts Evidence And intervention. 2000. Chichester: Wiley;28–63.
3. Lieberman J, Jody D, Geisler S, Alvir J, Loebel A, Szymanski S, et al. Time course and biologic correlates of treatment response in first-episode schizophrenia. Arch Gen Psychiatry. 1993. 50:369–376.
4. Larsen TK, Moe LC, Vibe-Hansen L, Johannessen JO. Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophr Res. 2000. 45:1–9.
5. Chung S, Bahk WM, Kwon JS, Park JH, Ahn JH, Goh J, et al. Symptom remission and functional outcomes in patients with recent-onset schizophrenia: a one-year prospective observational study. J Korean Neuropsychiatr Assoc. 2007. 46:480–491.
6. Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999. 56:241–247.
7. Gilbert PL, Harris MJ, McAdams LA, Jeste DV. Neuroleptic withdrawal in schizophrenic patients. A review of the literature. Arch Gen Psychiatry. 1995. 52:173–188.
8. Cho MJ, Sung SJ, Shin SY, Kim JS, Jun SB, Kim MJ, et al. The epidemiological survey of psychiatric illnesses in Korea. 2011. Seoul: Ministry of Health and Welfare;355–358.
9. Park JI, Chang HS, Lee JS, LEE MS. Structural causes and perpetuation factors of chronic institutionalization. 2008. Seoul: National Human Rights of Korea;131–143.
10. Jung YC. Kyolchongjok sigi ui chongsin punyolbyong hwanja rul wihan chongsin sahoejok chungjae. 2008. Seoul: HakJisa;255–278.
11. Edwards J, McGorry PD. YS Kim YM Shin CA Lee HY Jeong . Implementing early intervention in psychosis. 2007. Chungang Munhwasa;165–166.
12. Hastrup LH, Kronborg C, Bertelsen M, Jeppesen P, Jorgensen P, Petersen L, et al. Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study). Br J Psychiatry. 2013. 202:35–41.
13. Early Psychosis Intervention Program. EPI (Early psychosis intervention) service and clinical guidelines. 2006. Vancouver: Canadian Mental Health Association;1–20.
14. Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ. 2004. 329:1067.
15. Lee MS, Lee DW, Lee JY. Service standard and performance indicator development for the community mental health center. 2006. Seoul: Ministry of Health and Welfare;61–63.
16. Seoul Mental Health Center. Annual Report. 2008. 77–79.
17. Lee MS, Ahn SR, Park JI, Chung YC. Development of an early psychosis intervention system in Korea: focus on the continuing care system for first-episode psychosis treatment in Seoul. East Asian Arch Psychiatry. 2012. 22:105–109.
18. Seoul Mental Health Center. TWO STEP: Social Treatment for Early Psychosis Program. 2011.
19. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987. 13:261–276.
20. Yi JS, Ahn YM, Shin HK, An SK, Joo YH, Kim SH, et al. Reliability and validity of the Korean version of the positive and negative syndrome scale. J Korean Neuropsychiatr Assoc. 2001. 40:1090–1105.
21. Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry. 1998. 172:11–18.
22. Song JH. Clinical usefulness of the korean version of the health of the nation outcome scales (HoNOS). 2010. Seoul: St. Inje University, Korea.
23. Yi JS, Chung MH, Lee BW, Lee SI. Reliability and validity of the Korean version of global assessment of Functioning Scale. Korean J Schizophr Res. 2003. 6:118–124.
24. Amador XF, Flaum M, Andreasen NC, Strauss DH, Yale SA, Clark SC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994. 51:826–836.
25. Song JY, Kim KT, Lee SK, Kim YH, Noh JH, Kim JW, et al. Reliability and validity of the Korean version of the scale to assessment unawareness of mental disorder (SUMD-K). J Korean Neuropsychiatr Assoc. 2006. 45:307–315.
26. Chen EY, Tang JY, Hui CL, Chiu CP, Lam MM, Law CW, et al. Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Interv Psychiatry. 2011. 5:315–323.
27. Montreuil TC, Cassidy CM, Rabinovitch M, Pawliuk N, Schmitz N, Joober R, et al. Case manager- and patient-rated alliance as a predictor of medication adherence in first-episode psychosis. J Clin Psychopharmacol. 2012. 32:465–469.
28. Macneil CA, Hasty M, Cotton S, Berk M, Hallam K, Kader L, et al. Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study. Early Interv Psychiatry. 2012. 6:380–388.
29. Yoo JM, Ahn SR, Cho YS, Lee MS. A study of duration of untreated psychosis (DUP) for first episode psychosis. 2011. Seoul: Mental Health Center: The mental Health;12–16.
30. Barnes TR, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Joyce EM. West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis. Br J Psychiatry. 2000. 177:207–211.
Similar articles