Joint Crisis Plan Effectiveness in Preventing Relapses in Schizophrenia and Schizoaffective Disorder

Single blind multicentre randomised trial with parallel control groups.

2 groups:

• SOS Intervention Group: benefits from the SOS Plan in addition to the usual follow-ups
• "Control" Group: receive no additional intervention (only receive the routine follow-ups)

OBJECTIVES :

• To evaluate the effectiveness of the SOS Plan (JCP) in terms of the reduction in hospitalisations within 18 months of its development by comparison to the standard psychiatric care
• To evaluate :

• the cumulative length of hospitalisations (in days) in the two years following the development of the SOS plan
• the type of hospitalisation (voluntary or compulsory)
• the number of hospitalisations for a given subject
• the number of crisis situations that may require the use of the SOS Plan
• the clinical condition of the patient
• the patient with the most responses to the SOS Plan in socio-demographic terms
• the patient satisfaction in using the SOS Plan
• the decisional autonomy during treatment
• the quality of the therapeutic alliance
• the length of the meeting to develop the SOS Plan
• the quality of life
• the medico-economic impact

EXECUTION OF PRACTICAL RESEARCH :

• The inclusion visit will be completed apart from a period of acute psychiatric decompensation, while the patient is capable of consenting to treatment. The inclusion visit will be completed within a hospital department before the patient is finally released from hospitalisation or during an outpatient follow-up.

This involves placing the patient on the Positive And Negative Syndrome Scale (PANSS) to ensure that the patient's clinical condition allows him to consent to treatment. A score above 95 excludes the patient.

The investigator also outlines the study and schedules visits. The patient then signs both the information letter and informed consent.

A urine pregnancy test will be carried out on women of childbearing age.

• Randomisation will be performed by a member of the SOS regional-referral team.

For patients in the SOS Intervention group:

• Preparatory interview with an SOS regional referrer
• SOS Plan development meeting in the presence of the patient, the treating psychiatrist, one or more relatives, and an SOS regional referrer

For patients in the control group: tracking the continuation of psychiatric care according to the standard care terms

3 ) Follow-up visits: for the two groups: 4 visits M6, M12, M18, M24 At each visit: meeting with an independent regional SOS assessor blind to allocation.

For both of the groups:

• Assessment of the clinical condition: placement on the PANSS scale
• Number of psychiatric hospitalisations, types of hospitalisation, duration of hospitalisation since the last visit
• Satisfaction assessment (numeric scale), of the therapeutic alliance (WAI), of decision-making autonomy (API), of quality of life (SF-36)

For the SOS Intervention group:

• Updating the SOS Plan after each relapse that leads to an unscheduled psychiatric hospitalisation lasting more than two weeks.
• Updating the SOS Plan every 6 months in the absence of hospitalisation

Inclusion criteria

• Aged between 18 and 65 years
• Diagnosed with schizophrenia or schizoaffective disorder according to criteria specified in DSM
• Psychiatric inpatient or an outpatient with a specialised framework of psychiatric follow-ups
• Patient has been hospitalised at least once in a psychiatric department within the previous 2 years
• Adults under protective measures can be included (guardianship/supervision). Consent will also be sought from the guardian or trusted person.
• Registered for social security

Exclusion criteria

• Refusal to participate in the study
• Unable to give his or her written consent
• Patients detained
• Pregnant or lactating women