Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T12:57:30.309Z Has data issue: false hasContentIssue false

Early Psychosis: Where we've been, where we still have to go

Published online by Cambridge University Press:  18 May 2011

Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Early intervention in psychosis, while not a new concept, has seen great development over the last 15 years. Growth in this time has occurred in a number of areas and has attracted a broad coalition of researchers, consumers, clinicians, carers and policy makers. In this time the concept of early intervention has moved from the fringes to the mainstream of clinical approaches to psychosis in many places, and is doing so in even more. After a decade and a half, this paper reviews some of the key issues that have been addressed and points to areas where further growth and reform is still required. Some issues that have created controversy are examined here including pre-onset intervention and identification, the relationship of duration of untreated psychosis (DUP) to outcome and whether or not early intervention is an effective and economically viable model. Areas that are only now developing or which require further investigation are considered, including the concept of stages of mental illness and concomitant interventions, closing the efficacy-effectiveness gap and an increased focus on functioning as part of the recovery process. Early intervention in psychosis started as a reformist movement, agitating for change from outside the mainstream. Change has occurred and now early intervention is part of the mainstream approach to psychotic illness. In order to continue to develop, while enjoying the benefits of being a mainstream intervention, early intervention must not stray too far from its reformist roots.

Type
Editorials
Copyright
Copyright © Cambridge University Press 2007

References

Addington, J., Ledger, E. & Addington, D. (2003a). Symptom outcome 1 year after admission to an early psychosis program. Canadian Journal of Psychiatry 48,204207.CrossRefGoogle Scholar
Addington, J., Young, J. & Addington, D. (2003b). Social outcome in early psychosis. Psychological Medicine 33, 11191124.CrossRefGoogle ScholarPubMed
Bell, R.Q. (1992). Multiple risk cohorts and segmenting risk as solutions to the problems of false positives in risk for the major psychoses. Psychiatry 55, 370381.CrossRefGoogle Scholar
Birchwood, M. & Fiorillo, A. (2000). The critical period for early intervention. Psychiatric Rehabilitation Skills, Special Issue 4, 182198.CrossRefGoogle Scholar
Birleson, P.Luk, E.S. & Mileshkin, C (2001). Better mental health services for young people: responsibility, partnerships and projects. Australian and New Zealand Journal of Psychiatry 35, 3644.CrossRefGoogle ScholarPubMed
Craig, T.K., Garety, P., Power, P., Rahaman, N., Colbert, S., Fornells-Ambrojo, M. & Dunn, G. (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067CrossRefGoogle ScholarPubMed
Crowther, R.E., Marshall, M., Bond, G.R. & Huxley, P. (2001). Helping people with severe mental illness to obtain work: Systematic review. British Medical Journal 322, 204208.CrossRefGoogle ScholarPubMed
Cullberg, J., Mattsson, M., Levander, S., Holmqvist, R., Tomsmark, L., Elingfors, C. & Wieselgren, I.M. (2006). Treatment costs and clinical outcome for first episode schizophrenia patients: a 3-year follow-up of the Swedish ‘Parachute Project’ and Two Comparison Groups. Ada Psychiatrica Scandinavica 114, 274281.CrossRefGoogle ScholarPubMed
Drake, R.J. & Lewis, S.W. (2005). Early detection of schizophrenia. Current Opinion in Psychiatry 18, 147150.CrossRefGoogle ScholarPubMed
Edwards, J., Harrigan, S.M., McGorry, P.D. & Amminger, P.G. (2002). Duration of untreated psychosis (DUP) and outcome in schizophrenia. Psychological Medicine 32, 563564.CrossRefGoogle ScholarPubMed
Francey, S.M., Jackson, H.J., Phillips, L.J., Wood, S.J., Yung, A.R. & McGorry, P.D. (2005). Sustained attention in young people at high risk of psychosis does not predict transition to psychosis. Schizophrenia Research 79, 127136.CrossRefGoogle Scholar
Garety, P.A., Craig, T.K., Dunn, G., Fornells-Ambrojo, M., Colbert, S., Rahaman, N., Read, J. & Power, P. (2006). Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial. British Journal of Psychiatry 188, 3745.CrossRefGoogle ScholarPubMed
Gleeson, J.F., Rawlings, D., Jackson, H.J. & McGorry, P.D. (2005). Early warning signs of relapse following a first episode of psychosis. Schizophrenia Research 80, 107111.CrossRefGoogle ScholarPubMed
Hafner, H. & Maurer, K. (2006). Early detection of schizophrenia: current evidence and future perspectives. World Psychiatry 5, 130138.Google ScholarPubMed
Hambrecht, M., Lammertink, M., Klosterkötter, J., Matuschek, E. & Pukrop, R. (2002). Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic. British Journal of Psychiatry 181, s30–s37.CrossRefGoogle Scholar
Harrigan, S.M., McGorry, P.D. & Krstev, H. (2003). Does treatment delay in first-episode psychosis really matter? Psychological Medicine 33, 97110.CrossRefGoogle ScholarPubMed
Harris, M.G., Henry, L.P., Harrigan, S.M., Purcell, R., Schwartz, O.S., Farrelly, S.E., Prosser, A.L., Jackson, H.J. & McGorry, P.D. (2005). The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophrenia Research 79, 8593.CrossRefGoogle 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, 808815.CrossRefGoogle ScholarPubMed
Jeppesen, P., Petersen, L., Thorup, A., Abel, M.B., Oehlenschlaeger, J., Christensen, T.O., Krarup, G., Hemmingsen, R., Jorgensen, P. & Nordentoft, M. (2005). Integrated treatment of first-episode psychosis: effect of treatment on family burden: OPUS trial. British Journal of Psychiatry, Supplement 48, s8590.CrossRefGoogle ScholarPubMed
Johannessen, J.O., Larsen, T.K., Joa, I., Melle, I., Friis, S., Opjordsmoen, S., Rund, B.R., Simonsen, E., Vaglum, P. & McGlashan, T.H.. (2005). Pathways to care for first-episode psychosis in an early detection healthcare sector: part of the Scandinavian TIPS study. British Journal of Psychiatry, Supplement 48, s24–s28.CrossRefGoogle Scholar
Killackey, E. & Yung, A.R. (2007). Effectiveness of early intervention in psychosis. Current Opinion in Psychiatry 20, 121125.CrossRefGoogle ScholarPubMed
Killackey, E.J., Jackson, H.J., Gleeson, J., Hickie, I.B. & McGorry, P.D. (2006). Exciting Career Opportunity Beckons! Early Intervention and Vocational Rehabilitation in First Episode Psychosis: Employing Cautious Optimism. Australian and New Zealand Journalof Psychiatry 40, 951962.CrossRefGoogle ScholarPubMed
Kitchener, B.A. & Jorm, A.F. (2002). Mental health first aid training for the public: evaluation of effects on knowledge, attitudes and helping behavior. BMC Psychiatry 2, 10.CrossRefGoogle ScholarPubMed
Klosterkotter, J., Hellmich, M., Steinmeyer, E.M. & Schultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry 58, 158164.CrossRefGoogle ScholarPubMed
Linszen, D., Dingemans, P. & Lenior, M.E. (2001). Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: Ethical implications. Schizophrenia Research 51, 5561.CrossRefGoogle Scholar
Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P. & Croudace, T. (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62,975983.CrossRefGoogle ScholarPubMed
Marwaha, S. & Johnson, S. (2004). Schizophrenia and employment: A review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.CrossRefGoogle ScholarPubMed
Mason, O., Startup, M., Halpin, S., Schall, U., Conrad, A. & Carr, V. (2004). Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophrenia Research 71, 227237.CrossRefGoogle ScholarPubMed
McGlashan, T.H. (1999). Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899907.CrossRefGoogle ScholarPubMed
McGlashan, T.H., Zipursky, R.B., Perkins, D., Addington, J., Miller, T., Woods, S.W., Hawkins, K.A., Hoffman, R.E., Preda, A., Epstein, I., Addington, D., Lindborg, S., Trzaskoma, Q., Tohen, M. & Breier, A. (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. American Journal of Psychiatry 163, 790799.CrossRefGoogle ScholarPubMed
McGorry, P.D. (2000). Evaluating the importance of reducing the duration of untreated psychosis. Australian and New Zealand Journal of Psychiatry 34, Suppl. 34, s145s149.CrossRefGoogle ScholarPubMed
McGorry, P. (2005). ‘Every me and every you’: responding to the hidden challenge of mental illness in Australia. Australasian Psychiatry 13, 315.Google Scholar
McGorry, P.D. (in press). Investing in youth mental health is a best buy. Medical Journal of Australia.Google Scholar
McGorry, P.D. & Killackey, E.J. (2002). Early intervention in psychosis: a new evidence based paradigm. Epidemiologia e Psichiatria Sociale 11, 237247.CrossRefGoogle ScholarPubMed
McGorry, P.D., Yung, A.R., Phillips, L.J., Yuen, H.P., Francey, S., Cosgrave, E.M., Germano, D., Bravin, J., McDonald, T., Blair, A., Adlard, S. & 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, 921928.CrossRefGoogle Scholar
McGorry, P., Killackey, E., Lambert, T. & Lambert, M. (2005). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry 39, 130.Google Scholar
McGorry, P.D., Hickie, I.B., Yung, A.R., Pantelis, C. & Jackson, H.J. (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry 40, 616622.CrossRefGoogle ScholarPubMed
Melle, I., Haahr, U., Friis, S., Hustoft, K., Johannessen, J.O., Opjordsmoen, S., Simonsen, E., Rund, B.R., Vaglum, P. & McGlashan, T. (2005). Reducing the duration of untreated first-episode psychosis - effects on baseline social functioning and quality of life. Ada Psychiatrica Scandinavica 112, 469473.CrossRefGoogle ScholarPubMed
Melle, I., Larsen, T.K., Haahr, U., Friis, S., Johannessen, J.O., Larsen, T.K., Opjordsmoen, S., Rund, B.R., Simonsen, E., Vaglum, P. & McGlashan, T. (2004), Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Archives of General Psychiatry 61, 143150.CrossRefGoogle ScholarPubMed
Melle, I., Johannesen, J.O., Svein Friis, S., Haahr, U., Joa, I.,Larsen, T.K., Opjordsmoen, S., Rund, B.R., Simonsen, E., Vaglum, P. & McGlashan, T. (2006). Early detection of the first episode of schizophrenia and suicidal behavior. American Journal of Psychiatry 163, 800804.CrossRefGoogle ScholarPubMed
Mihalopoulos, C., McGorry, P.D. & Carter, R.C. (1999). Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome? Acta Psychiatrica Scandinavica 100, 4755.CrossRefGoogle ScholarPubMed
Morrison, A.P., French, P., Walford, L., Lewis, S.W., Kilcommons, A., Green, J., Parker, S. & Bentall, R.P. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291297.CrossRefGoogle ScholarPubMed
Mrazek, P. & Haggerty, R. (1994). Reducing Risks for Mental Disorders: Frontiers for Preventitive Intervention Research. National Academy Press: Washington DC.Google Scholar
NICE (2003). Schizophrenia: Full National Clinical Guideline on Core Interventions in Primary and Secondary Care. Gaskell & The British Psychological Society: London.Google Scholar
Nordentoft, M., Thorup, A., Petersen, L., Ohlenschlaeger, J., Melau, M., Christensen, T.O., Krarup, G., Jorgensen, P. & Jeppesen, P. (2006). Transition rates from schizotypal disorder to psychotic disorder for first-contact patients included in the OPUS trial. A randomized clinical trial of integrated treatment and standard treatment. Schizophrenia Research 83, 2940.CrossRefGoogle Scholar
Perkins, D.O., Gu, H., Boteva, K. & Lieberman, J.A. (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.CrossRefGoogle ScholarPubMed
Petersen, L., Nordentoft, M., Jeppesen, P., Ohlenschaeger, J., Thorup, A., Christensen, T.O., Krarup, G., Dahlstrom, J., Haastrup, B. & Jorgensen, P. (2005). Improving 1-year outcome in first-episode psychosis: OPUS trial. British Journal of Psychiatry, Supplement 48, s98103.CrossRefGoogle ScholarPubMed
Power, P.J., Bell, R.J., Mills, R., Herrman-Doig, T., Davern, M.,Henry, L., Yuen, H.P., Khademy-Deljo, A. & McGorry, P.D. (2003). Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis. Australian and New Zealand Journal of Psychiatry 37, 414420.CrossRefGoogle ScholarPubMed
Rosen, J.L., Miller, T.J., D'Andrea, J.T., McGlashan, T.H. & Woods, S.W. (2006). Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome. Schizophrenia Research 85, 124131.CrossRefGoogle ScholarPubMed
Ruhrmann, S., Schultze-Lutter, F., Maier, W. & Klosterkotter, J. (2005). Pharmacological intervention in the initial prodromal phase of psychosis. European Psychiatry 20, 16.CrossRefGoogle ScholarPubMed
Sullivan, H. (1927). The onset of schizophrenia. American Journal of Psychiatry 6, 105134.CrossRefGoogle Scholar
Svirskis, T., Korkeila, J., Heinimaa, M., Huttunen, J., Ilonen, T., Ristkari, T., McGlashan, T. & Salokangas, R.K. (2005). Axis-I disorders and vulnerability to psychosis. Schizophrenia Research 75, 439446.CrossRefGoogle ScholarPubMed
Thorup, A., Petersen, L., Jeppesen, P., Ohlenschlaeger, J., Christensen, T., Krarup, G., Jorgensen, P. & Nordentoft, M. (2005). Integrated treatment ameliorates negative symptoms in first episode psychosis-results from the Danish OPUS trial. Schizophrenia Research 79, 95105.CrossRefGoogle ScholarPubMed
Verdoux, H. & Cougnard, A. (2003). The early detection and treatment controversy in schizophrenia research. Current Opinion in Psychiatry 16, 175179.CrossRefGoogle Scholar
Verdoux, H., Liraud, F., Bergey, C, Assens, F., Abalan, F. & van Os, J. (2001). Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophrenia Research 49, 231241.CrossRefGoogle ScholarPubMed
Wade, D., Harrigan, S., Edwards, J., Burgess, P.M., Whelan, G. & McGorry, P.D. (2006). Substance misuse in first-episode psychosis: 15-month prospective follow-up study. British Journal of Psychiatry 189, 229234.CrossRefGoogle ScholarPubMed
Warner, R. (2001). The prevention of schizophrenia: what interventions are safe and effective? Schizophrenia Bulletin 27, 551562.CrossRefGoogle ScholarPubMed
Warner, R. (2002). Limitations of the Bonn Scale for the Assessment of Basic Symptoms as a screening measure. Archives of General Psychiatry 59, 470471.CrossRefGoogle ScholarPubMed
Warner, R. (2005). Problems with early and very early intervention in psychosis. British Journal of Psychiatry, Supplement 48, slO4–slO7.Google ScholarPubMed
Yung, A.R. (2003). Commentary: The Schizophrenia Prodrome: A High Risk Concept. Schizophrenia Bulletin 29, 859865.CrossRefGoogle ScholarPubMed
Yung, A.R., Phillips, L.J. & McGorry, P.D. (2004). Treating Schizophrenia in the Prodromal Stage. Taylor & Francis: London.CrossRefGoogle Scholar
Yung, A.R., Stanford, C, Cosgrave, E., Killackey, E., Phillips, L., Nelson, B. & McGorry, P.D. (2006). Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophrenia Research 84, 5766.CrossRefGoogle Scholar
Yung, A.R., Yuen, H.P., Berger, G., Francey, S., Hung, T., Nelson, B., Phillips, L. & McGorry, P.(in press). Declining transition rate in Ultra High Risk (prodromal) services: dilution or reduction of risk? Schizophrenia Bulletin.Google Scholar