Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T10:24:09.452Z Has data issue: false hasContentIssue false
  • English
  • Français

Early intervention in schizophrenia: a critique

Published online by Cambridge University Press:  11 October 2011

Richard Warner
Richard Warner*
Affiliation:
Mental Health Center of Boulder County, University of Colorado, Boulder (CO), USA
*
Address for correspondence: Professor R. Warner, Mental Health Center of Boulder County, 1333 Iris Avenue, Boulder, Colorado 80302 (USA). E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Objective – Two forms of early intervention in psychosis are currently being proposed — intervention before the onset of illness with at-risk individuals and intervention after the onset of psychosis. Method – The risks and potential benefits associated with these two approaches were examined using published data and Bayes probability theorem. Results -Claims for benefits from early intervention in established psychosis go back more than two hundred years to the nineteenth-century advocates for asylum construction. Theoretical support for early intervention in psychosis rests on data suggesting that a longer duration of untreated psychosis (DUP) is associated with poor outcome. The association of DUP with outcome, however, appears to be inseparable from the confounding influence of the good outcome expected in recent-onset psychosis. Although some researchers advocate treating people with premorbid features of psychosis or other high-risk indicators, adequate screening measures and effective interventions are not yet available. The most promising current screening measure, if applied to the general population, would be accurate only two percent of the time. The accuracy of these measures can be improved by screening only those patients who are referred to a clinic, but this strategy will result in many cases in the population-at-large being overlooked. Discussion – The risks and potential benefits associated with the two early intervention approaches are very different. The provision of optimal treatment early in psychosis could produce benefits, but people with brief, good-prognosis psychotic episodes are likely to receive unnecessary treatment. Screening the general population or patients referred to a clinic will have little public health impact on the incidence of schizophrenia. There is likely to be considerable negative impact on those who are inaccurately labeled as being at imminent risk of psychosis and are treated accordingly.

Keywords

preventionschizophreniaobstetric complicationsearly interventionrisk assessment
Type
Invited Papers
Information
Epidemiology and Psychiatric Sciences , Volume 11 , Issue 4 , December 2002 , pp. 248 - 255
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Barnes, T.R.E., Hutton, S.B., Chapman, M.J., Mutsatsa, S., Puri, B.K. & Joyce, E.M. (2000). West London first-episode study of schizophrenia: clinical correlates of duration of untreated psychosis. Britsh Journal of Psychiatry 111, 207–211.Google Scholar
Bola, J.R. & Mosher, L.R. (2001). Treating psychosis without drugs: Soteria two-year outcomes. In World Psychiatric Association International Congress, Madrid, Spain.Google Scholar
Browne, S., Clarke, M., Gervin, M., Waddington, J.L., Larkin, C. & O'Callaghan, E. (2000). Determinants of quality of life at first presentation for schizophrenia. British Journal of Psychiatry 176, 173–176.CrossRefGoogle ScholarPubMed
Caplan, G. (1964). The Principles of Preventive Psychiatry. Basic Books: New York.Google Scholar
Carbone, S., Harrigan, S., McGorry, P.D.Curry, C. & Elkins, K. (1999). Duration of untreated psychosis & 12-month outcome in first-episode psychosis: the impact of treatment approach, Ada Psychiatrica Scandinavica 100, 96–104.Google Scholar
Carr, V., Halpin, S., Lau, N., O'Brian, S., Beckman, J. & Lewin, T. (2000). A risk factor screening and assessment protocol for schizophrenia and related psychosis. Australian and New Zealand Journal of Psychiatry 34, Suppl., S170–S180.Google Scholar
Ciompi, L. (1980). Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin 6, 606–618.CrossRefGoogle ScholarPubMed
Ciompi, L., Dauwalder, H.-P., Maier, C., Aebi, E., Trutsch, K., Kupper, Z. & Rutishauser, C. (1995). The pilot project “Soteria Berne”: clinical experiences and results. In Alternatives to the Hospital for Acute Psychiatric Treatment (ed. Warner, R.), pp. 133–151. American Psychiatric Press: Washington, DC.Google Scholar
Craig, T.J., Bromet, E.J., Fennig, S., 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, 60–66.Google Scholar
Crow, T.J., MacMillan, J.F., Johnson, A.L. & Johnstone, E.C. (1986). A randomised controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry 148, 120–127.Google Scholar
de Haan, L., van der Gaag, M. & Wolthaus, J. (2000). Duration of untreated psychosis and the long-term course of schizophrenia. European Psychiatry 15, 264–267.CrossRefGoogle ScholarPubMed
Drake, R.J., Haley, C.J., Akhtar, S. & Lewis, S.W. (2000). Causes and consequences of duration of untreated psychosis in schizophrenia. British Journal of Psychiatry 177, Suppl., S511–S515.Google Scholar
Everitt, B.S. (1999). Cliance Rules: An Informal Guide to Probability, Risk, and Statistics. Copernicus, Springer-Verlag: New York.Google Scholar
Falloon, I. (1992). Early intervention for first episodes of schizophrenia: a preliminary exploration. Psychiatry 55, 4–15.Google Scholar
Fannon, D., Chitnis, X., Doku, V., Tennakoon, I., O'Ceallaigh, S., Soni, W., Sumich, A., Lowe, J., Santamaria, M. & Sharma, T. (2000). Features of structural brain abnormality detected in first-episode psychosis. American Journal of Psychiatry 157, 1829–1834.Google Scholar
Goode, E. (1999). Doctors try a bold move against schizophrenia. New York Times, pp. Dl & D6.Google Scholar
Haas, G.L., Garrett, L.S. & Sweeney, J.A. (1998). Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. Journal of Psychiatric Research 32, 151–159.Google Scholar
Helgason, L. (1990). Twenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been prevented ? Ada Psychiatrica Scandinavica 81, 231–235.Google Scholar
Ho, B-C. & Andreasen, N.C. (2001). Commentary. Lancet 357, 898–900.CrossRefGoogle Scholar
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
Hoff, A.L., Sakuma, M., Razi, K., Heydebrand, G., Csernansky, J.G. & De Lisi, L.E. (2000). Lack of association between duration of untreated illness and severity of cognitive and structural brain deficits at the first episode of schizophrenia. American Journal of Psychiatry 157, 1824–1828.Google Scholar
Jablensky, A. (2000). Prevalence and incidence of schizophrenia spectrum disorders: implications for prevention, Australian and New Zealand Journal of Psychiatry 34 Suppl., S26–S34.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Crow, T. J., Johnson, A. L. & Macmillan, J.F. (1986) The Northwick Park study of first episodes of schizophrenia: I. Presentation of the illness and problems relating to admission, British Journal of Psychiatry, 148, 115–120.Google Scholar
Jones, P.B., Bebbington, P., Foerster, A., Lewis, S.W., Murray, R.M., Russell, A., Sham, P.C., Toone, B.K. & Wilkins, S. (1993). Premorbid social underachievement in schizophrenia: results of the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry 162, 65–71.Google Scholar
Klosterkotter, J., Hellmich, M., Steinmeyer, E.M. & Shultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry 58, 158–164.Google Scholar
Larsen, T.K., Moe, L.C., Vibe-Hansen, L. & Johannesen, J.O. (2000). Premorbid functioning versus duration of untreated psychosis in 1-year outcome in first-episode psychosis. Schizophrenia Research 45, 1–9.Google Scholar
Larsen, T.K., Friis, S., Haarh, U., Joa, I., Johannessen, J.O., 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.Google Scholar
Larsen, T.K., McGlashan, T.H., Johannessen, J.O., Friis, S., Guldberg, C., Haarh, U., Homeland, M., Melle, I., Moe, L.C., Opjdordsmoen, S., Simonsen, E. & Vaglum, P. (in press). Reducing duration of untreated first episode psychosis: changes in patient characteristics at presentation. American Journal of Psychiatry.Google Scholar
Lehtinen, V., Aaltonen, J., Koffert, T., Rakkolainen, V. & Syvalahti, E. (2000). Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation needed ? European Psychiatry 2000, 312–320.CrossRefGoogle Scholar
Lieberman, J.A. (1999). Importance of early diagnosis and treatment of schizophrenia. NARSAD Research Newsletter 11, 4–6.Google Scholar
Linszen, D., Lenior, M., de Haan, L. & Dingemans, P. (1998). Early intervention, untreated psychosis and the course of early schizophrenia. British Journal of Psychiatry 172, 84–89.Google Scholar
Loebel, A.D., Lieberman, J.A., Alvir, J.M.J., Mayerhoff, D.I., Geisler, S.H. & Szymanski, S.R. (1992). Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry 149, 1183–1188.Google Scholar
Makanjuola, R.O.A. & Adedapo, S.A. (1987). The DSM-III concepts of schizophrenic disorder and schizophreniform disorder: a clinical and prognostic evaluation. British Journal of Psychiatry 151, 611–618.Google Scholar
McGlashan, T.H., Miller, T.J. & Woods, S.W. (2001). Preonset detection and intervention researchin schizophrenia psychoses: current estimates of benefit and risk. Schizophrenia Bulletin 27, 563–570.Google Scholar
McGorry, P.D. (2000). The nature of schizophrenia: signposts to prevention. Australian and New Zealand Journal of Psychiatry 34, Suppl.,S14–S21.CrossRefGoogle ScholarPubMed
McGorry, P.D. & Edwards, J. (2002). Response to “The prevention of schizophrenia: what interventions are safe and effective?” [Letter to the editor]. Schizophrenia Bulletin 28, 177–180.CrossRefGoogle Scholar
McGorry, P.D. & Jackson, H.J. (1999). The Recognition and Management of Early Psychosis. Cambridge University Press: Cambridge.Google Scholar
McGorry, P.D., McFarlane, C., Patton, G.C., Bell, R., Hibbert, M.E., Jackson, H.J. & Bowes, G. (1995). The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey. Ada Psychiatrica Scandinavica 90, 375–378.Google Scholar
McGorry, P.D., Edwards, J., Mihalopoulos, C., Harrigan, S.M. & Jackson, H.J. (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305–326.Google Scholar
Moscarelli, M., Capri, S. & Neri, L. (1991). Cost evaluation of chronic schizophrenic patients during the first three years after the first contact. Schizophrenia Bulletin 17, 421–426.Google Scholar
Mosher, L.R. (1995). The Soteria Project: the first generation American alternatives to psychiatric hospitalization. In Alternatives to Hospital for Acute Psychiatric Treatment (ed. Warner, R.), pp. 111–129. American Psychiatric Press: Washington, DC.Google Scholar
Norman, R.M.G., Townsend, L. & Malla, A.. (2001). Duration of untreated psychosis and cognitive functioning in first-episode patients. British Journal of Psychiatry 179, 340–345.Google Scholar
Parry-Jones, W.L. (1972). The Trade in Lunacy. A Study of Private Madhouses in England in tlie Eighteenth and Nineteenth Centuries. Routledge & Kegan Paul: London.Google Scholar
Phillips, L.J., Yung, A.R. & McGorry, P.D. (2000). Identification of young people at risk of psychosis: Validation of Personal Assessment and Crisis Evaluation Clinic intake criteria. Australian and New Zealand Journal of Psychiatry 34, Suppl., S164–S169.Google Scholar
Scull, A.T. (1979). Museums of Madness. The Social Organization of Insanity in Nineteenth-Century England. St. Martin's Press: New York.Google Scholar
Scully, P.J., Coakley, G., Kinsella, A. & Waddington, J.L. (1997). Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated versus subsequently treated psychosis in chronic schizophrenia. Psychological Medicine 27, 1303–1310.CrossRefGoogle ScholarPubMed
Shepherd, M., Watt, D., Falloon, I. & Smeeton, M. (1989). The natural history of schizophrenia: a five-year follow-up in a representative sample of schizophrenics. Psychological Medicine, Monograph Supplement no. 15.Google Scholar
Tsoi, W.F. & Wong, K.E. (1991). A 15-year follow-up study of Chinese schizophrenic patients. Ada Psychiatrica Scandinavica 84, 217–220.CrossRefGoogle ScholarPubMed
US Department of Health and Human Services (1996). Guide to Clinical Preventive Services. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services: Washington, DC.Google Scholar
Waddington, J.L., Youssef, H.A. & Kinsella, A. (1995). Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia. Psychological Medicine 25, 849–857.Google Scholar
Warner, R. (1994). Recovery from Schizophrenia: Psychiatry and Political Economy. Routledge: New York.Google Scholar
World Health Organization (1979). Schizophrenia: an International Follow-up Study. Wiley: Chichester.Google Scholar
Wyatt, R.J., Green, M.F. & Tuma, A.H. (1997). Long-term morbidity associated with delayed treatment of first admission schizophrenic patients. Psychological Medicine 27, 261–268.Google Scholar
Yung, A.R. & Jackson, H.J. (1999). The onset of psychotic disorder: clinical and research aspects. In The Recognition and Management of Early Psychosis (ed. McGorry, P.D. and Jackson, H.J.), pp. 27–50. Cambridge University Press: Cambridge.Google Scholar
Yung, A.R. & McGorry, P.D. (1997). Is pre-psychotic intervention realistic in schizophrenia and related disorders? Australian and New Zealand Journal of Psychiatry 31, 799–805.Google Scholar