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Early intervention in psychosis: a new evidence based paradigm

Published online by Cambridge University Press:  11 October 2011

Patrick D. McGorry  and
Eoin J. Killackey
Patrick D. McGorry*
Affiliation:
Early Psychosis Prevention & Intervention Centre, Victoria, Australia
Eoin J. Killackey
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne, Melbourne, Australia
*
Address for correspondence: Professor P. McGorry, MH-SKY 35 Popular Road – Parkvile, 3052 victoria (Australia). Fax: +61-3-9342.2948 E-mail: [email protected]
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Summary

Objective – Even in countries whose mental health services are comparatively well resourced, the care offered to those in the early stages of psychotic illnesses is not what it could be. Patients often have to progress to chronicity before receiving adequate interventions, by which stage there has been great potential for harm, not only through the psychosis, but also to the quality of life of the individual who has often missed or not completed adequately, several important developmental tasks. Further, evidence indicates that delay in treatment is positively associated with poorer outcome. This paper puts the case for early intervention in psychosis. Method – Based on the experience of the Early Psychosis Prevention and Intervention Centre in Melbourne, the paper reviews the evidence for and the criticisms of, early intervention. Using the concept of indicated prevention, it suggests ways in which clinicians can improve the interventions available to those experiencing the onset of psychosis and suggests that prepsychotic intervention may be possible. Results – Evidence discussed in this paper indicates that the development of mental illness is a major health issue in young people; that there is a positive correlation between duration of untreated psychosis and outcome; that it is possible to identify a proportion of those at high risk of developing mental illness; that through intervention it may be possible to reduce the transition rate to illness. Conclusion – Primary prevention is beyond the capacity of our present knowledge. Indicated prevention in the form of early intervention and optimal, sustained treatment is a paradigm for which there is increasing supportive evidence. It is a paradigm which is appealing to clinicians, patients, families and which has the potential to reduce the secondary impact of serious mental illness such as suicide, stigma, isolation and reduction in social status.

Keywords

first episode psychosisearly interventionpre-psychotic interventionphase specific interventionearly detection
Type
Invited Papers
Information
Epidemiology and Psychiatric Sciences , Volume 11 , Issue 4 , December 2002 , pp. 237 - 247
Copyright
Copyright © Cambridge University Press 2002

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References

REFERENCES

Altamura, A.C., Basetti, R., Sassella, F.,Salvodori, D. & Mundo, E. (2001). Duration of untreated psychosis as a predictor of outcome in first episode schizophrenia: a retrospective study. Schizophrenia Research 52, 29–36.CrossRefGoogle ScholarPubMed
Berger, G.E., Wood, S.J., Pantelis, C, Velakoulis, D., Wellard, R.M. & McGorry, P.D. (2002). Implications of lipid biology for the pathogenesis of schizophrenia. Australia aiidNew Zealand Journal of Psychiatry 36, 355–566.CrossRefGoogle ScholarPubMed
Birchwood, M, Todd, P. & Jackson, C. (1998). Early intervention in psychosis: the critical period hypothesis. British Journal of Psychiatry 172, Suppl. 33, 53–59.CrossRefGoogle Scholar
Bywaters, J.L. (in press). First episode psychosis: establishment of fifty early intervention teams in die United Kingdom. In Early Psycliosis Symposium (ed. McGorry, P. and Yung, A.). Australian and New Zealand Journal of Psychiatry.Google Scholar
Carbone, S., Harrigan, S., McGorry, P., Curry, C. & Elkins, K. (1999). Duration of untreated psychosis and 12 month outcome in first-episode psychosis: the impact of treatment approach. Acta Psychiatrica Scandinavica 100, 96–104.CrossRefGoogle ScholarPubMed
Carpenter, W.T. (2001). Evidence-based treatment for first-episode schizophrenia? American Journal of Psychiatry 158, 1771–1773.CrossRefGoogle ScholarPubMed
Craig, T.J., Bromet, E.J., Fennig, S., Tanenberg-Karant, M., Lavelle, J. & Galambos, N. (2000). Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? American Journal of Psychiatry 157(1), 60–66.Google Scholar
Csernansky, J.G., Mahmoud, R. & Brenner, R. (2002). A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. New England Journal of Medicine 346,16–22.CrossRefGoogle ScholarPubMed
Driessen, G., Gunther, N., Bak, M., van-Sambeek, M. & van-Os, J. (1998). Characteristics of early- and late-diagnosed schizophrenia: implications for first-episode studies. Schizophrenia Research 33(1–2), 27–34.CrossRefGoogle ScholarPubMed
Eaton, W.W., Badawi, M. & Melton, B. (1995). Prodromes and precursors: epidemiological data for primary prevention of disorders with slow onset American Journal of Psychiatry 152, 967–972.Google Scholar
Edwards, J. & McGorry, P. (2002). Implementing Early Intervention in Psychosis: a Guide to Establishing Early Psychosis Services. Dunitz: London.Google Scholar
Garety, P.A. & Rigg, A. (2001). Early psychosis in the inner city: a survey to inform service planning. Social Psychiatry and Psychiatric Epidemiology 36, 537–544.CrossRefGoogle ScholarPubMed
Gitlin, M., Nuechterlein, K., Subotnik, K.L., Ventura, J., Mintz, J., Fogelson, D.L., Bartzokis, G. & Aravargiri, M. (2001). Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. American Journal of Psychiatry 158, 1835–1842.Google Scholar
Häfner, H., Löftier, W., Maurer, K., Hambrecht, M. & van der Heiden, W. (1999). Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatrica Scandinavica 100,105–118.CrossRefGoogle ScholarPubMed
Harrison, G., Hopper, K., Craig, T., Laska, E., Siegel, C, Wanderling, J., Dube, K.C., Ganev, K., Giei, R., An der Heiden, W., Holmberg, S.K., Janca, A., Lee, P.W.H, Leon, C.A., Malhotra, S., Marsella, A.J., Nakane, Y, Sartorius, N., Shen, Y., Skoda, C, Thara, R., Tsirkin, S.J., Varma, V.K., Walsh, D. & Wiersma, D. (2001). Recovery from psychotic illness: a 15- and 25-year international follow-up study. British Journal of Psychiatry 178, 506–517.CrossRefGoogle ScholarPubMed
Hegarty, J., Baldessarini, R., Tohen, M., Wateraaux, C. & Oepen, G. (1994). One hundred years of schizophrenia: a meta-analysis of the outcome literature. American Journal of Psychiatry 151, 1409–1416.Google ScholarPubMed
Ho, B.C., Andreasen, N.C., Flaum, M., Nopoulos, P. & Miller, D. (2000). Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. American Journal of Psychiatry 157, 808–815.Google Scholar
Jablensky, A., McGrath, J., Herrman, H., Castle, D., Gureje, O., Evans, M., Carr, V., Morgan, V., Korten, A. & Harvey, C. (1999). People living with Psychotic Illness: an Australian Study 1997–98. An Overview. Overview of the Metliod and Results of Low Prevalence (Psycliotic) Disorders as Part oftlie National Survey of Mental Health and Wellbeing. On behalf of Low Prevalence Disorders Study Group, Commonwealth Department of Health and Age Care: Canberra, Australia.Google Scholar
Jackson, H., McGorry, P.D., Edwards, J., Hulbert, C, Henry, L., Francey, S., Maude, D., Cocks, J., Power, P., Harrigan, S. & Dudgeon, P. (1998). Cognitively-oriented psychotherapy for early psychosis (COPE). Preliminary results. British Journal of Psychiatry 172, Suppl.33,93–100.CrossRefGoogle ScholarPubMed
Jones, P. (2000). The epidemiology of psychotic disorders. Keynote address at 2nd International Conference on Early Psychosis “Future Possible”, New York, 31 March -2 April.Google Scholar
Kapur, S., Zipursky, R., Jones, C, Remington, G. & Houle, S. (2000). Relationship between dopamine D2 occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. American Journal of Psychiatry 157(4), 514–520.CrossRefGoogle ScholarPubMed
Klosterkotter, J., Hellmich, M., Steinmeyer, E.M. & Schultze-Lutter, F. (2001). Diagnosing schizophraeia in the initial prodromal phase. Archives of General Psychiatry 58, 158–164.CrossRefGoogle ScholarPubMed
Larsen, T.K., Friis, S., Haahr, U., Joa, I., Johannssen, J.A., Melle, I., Opjordsmoen, S., Simonsen, E. & Vaglum, P. (2001). Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatrica Scandinavica 103, 323–334.CrossRefGoogle ScholarPubMed
Lawrence, D., Holman, C.D.J., Jablensky, A.V., Fuller, S.A. & Stoney, A.J. (2001). Increasing rates of suicide in Western Australian psychiatric patients: a record linkage study. Acta Psychiatrica Scandinavica 104,443–451.Google Scholar
Lehman, A.F. & Steinwachs, D.M. (1998). The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations. Schizophrenia Bulletin 24(1), 1–10.Google Scholar
Lieberman, J.A. &Fenton, W.S. (2000). Delayed detection of psychosis: causes, consequences, and effect on public health. American Journal of Psychiatry 157, 1727–1730.CrossRefGoogle ScholarPubMed
Linszen, D., Dingemans, P. & Lenior, M. (2001). Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications. Schizophrenia Research 51, 55–61.Google Scholar
Malla, A.K. & Norman, R.M.G. (2002). Early intervention in schizophrenia and related disorders: advantages and pitfalls. Current Opinion in Psychiatry 15, 17–23.Google Scholar
Malla, A.K., McLean, T.S. & Townsend, L.A. (in press). Early intervention in psychosis: a Canadian perspective. In Early Psychosis Symposium (ed. McGorry, P. and Yung, A.). Australia and New Zealand Journal of Psychiatry.Google Scholar
McGlashan, T. (1999). Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899–907.CrossRefGoogle ScholarPubMed
McGorry, P.D. (2000). Evaluating the importance of reducing the duration of untreated psychosis. Australia and New Zealand Journal of Psychiatry 34, S145–149.Google Scholar
McGorry, P.D. & Jackson, H.J. (ed.) (1999). The Recognition and Management of Early Psychosis: a Preventive Approach. Cambridge University Press: Cambridge.Google Scholar
McGorry, P.D., Chanen, A., McCarthy, E., Van Riel, R., McKenzie, D. & Singh, B.S. (1991). Post-traumatic stress disorder following recentonset psychosis: an unrecognised post-psychotic syndrome. Journal of Nervous and Mental Disease 179, 253–258.CrossRefGoogle Scholar
McGorry, P.D., Edwards, J., Mihalopoulos, C, Harrigan, S. & Jackson, H.J. (1996). The Early Psychosis Prevention and Intervention Centre (EPPIC): an evolving system of early detection and optimal management. Schizophrenia Bulletin 22(2), 305–326.CrossRefGoogle ScholarPubMed
McGorry, P.D., Henry, L. & Power, P. (1998). Suicide in early psychosis: could early intervention work? In Suicide Prevention: the Global Context (ed. Kosky, R.J., Eshkevan, H.S., Goldney, R.D. and Hassan, R.), pp. 103–110. Plenum: New York.Google Scholar
McGorry, P.D., Yung, A. & Phillips, L. (2001a). Ethics and early intervention in psychosis: keeping up the pace and staying in step. Schizophrenia Research 51(1), 17–22.Google Scholar
McGorry, P.D., Harrigan, S.M., Amminger, P., Norman, R. & Malla, A. (2001b). Letter “Untreated Initial Psychosis”. American Journal of Psychiatry 158, 1161–1162.CrossRefGoogle ScholarPubMed
McGorry, P.D., Yung, A.R., Phillips, L.J., Yuen, H.P., Francey, S., Cosgrave, E.M., Germano, D., Bravin, J., Adlard, S., McDonald, T., Blair, A. & Jackson, H. (2002). Randomized controlled trial of interventions designed to reduce the risk of progression to first episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry 59 (10), 921–928.Google Scholar
Mihalopoulos, G, McGorry, P. & Carter, R. (1999). Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome. Acta Psychiatrica Scandinavica 100,47–55.Google Scholar
Moody-Ayers, S.Y., Wells, C.K. & Feinstein, A.R. (2000). “Benign” tumors and “early detection” in mammography-screened patients of a natural cohort with breast cancer. Archives of Internal Medicine 160,1109–1115.Google Scholar
Mrazek, P.J. & Haggerty, R.J. (ed.) (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academy Press: Washington DC.Google Scholar
Nordentoft, M., Jeppesen, P. & Abel, M. (in press). OPUS-study: suicidal behaviour, suicidal ideation and hopelessness among first-episode psychotic patients. A one year follow-up of a randomised controlled trial. British Journal of Psychiatry.Google Scholar
Norman, R.M.G. & Malla, A.K. (2001). Duration of untreated psychosis: a critical examination of the concept and its importance. Psycliological Medicine 31, 381–400.Google Scholar
Nyberg, S., Faroe, L., HalkHn, C.Dahl, M.L. & Berdlsson, L. (1995). D2 dopamine receptor occupancy during low-dose treatmnt with haloperidol decanoate. American Journal of Psychiatry 152,173–178.Google Scholar
Padmavathi, R., Rajkumar, S. & Srinivasan, T. (1998) Schizophrenic patients who were never treated--a study in an Indian urban community. Psychological Medicine 28(5), 1113–1117.Google Scholar
Power, P. & McGorry, P.D. (1999). Initial assessment of first-episode psychosis. In Tlie Recognition and Management of Early Psychosis: a Preventive Approach (ed. McGorry, P.D. and Jackson, H.J.), pp. 155–183. Cambridge University Press: New York.Google Scholar
Power, P., Bell, R. & Mills, R. (in press). Suicide prevention in first episode psychosis. In Early Psychosis Symposium (ed. McGorry, P. and Yung, A.). Australia and New Zealand Journal of Psychiatry.Google Scholar
Public Health Division, Department of Human Services. (1999). Victorian Burden of Disease Study <http://www.dhs.vic.gov.au/phd/9909065/index.htm>..>Google Scholar
Robinson, D.G., Woerner, M.G., Alvir, J.M.A., Bilder, R., Goldman, R, Geisler, S., Koreen, A., Sheitman, B., Chakos, M., Mayerhoff, D. & Lieberman, J.A. (1999). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry 56, 241–247.Google Scholar
Rutter, M. & Smith, D.J. (1995). Psychosocial Disorders in Young People. Time Trends and their Causes. John Wiley: Chicester.Google Scholar
Schaffher, K.F. & McGorry, P.D. (2001). Preventing severe mental illnesses – new prospects and ethical challenges. Schizophrenia Research 51(1), 3–15.Google Scholar
Van Os, J., Hanssen, M., Bijl, R.V. & Vollebergh, W. (2001). Prevalence of psychotic disorder and community level of psychotic symptoms. Archives of General Psychiatry 58, 663–668.Google Scholar
Verdoux, H. (2001). Have the times come for early intervention in psychosis? Acta Psychiatrica Scandinavica 103, 321–322.Google Scholar
Warner, R. (2001) The prevention of Schizophrenia: what interventions are safe and effective? Schizophrenia Bulletin 27(4), 551–562.CrossRefGoogle ScholarPubMed
World Health Organization (2001). The World Health Report: 2001: Mental Health: New Understanding, New Hope. WHO: Geneva.Google Scholar
Yung, A.R., McGorry, P.D., McFarlane, C.A. & Jackson, H.J. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22(2), 283–303.Google Scholar
Yung, A.R., Phillips, L.J., McGorry, P.D., McFarlane, C.A., Francey, S., Harrigan, S., Patton, G.C. & Jackson, H.J. (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia? British Journal of Psychiatry 172 (suppl. 33), 14–20Google Scholar
Yung, A.R., Phillips, L.J., Yuen, H.P., Francey, S.M., McFarlane, C.A., Hallgren, M. & McGorry, P.D. (in press). Psychosis prediction: 12 month follow up of a high risk (“prodromal”) group. Schizophrenia Research.Google Scholar