Skip to main content Accessibility help
×
Home
Hostname: page-component-99c86f546-kpmwg Total loading time: 0.322 Render date: 2021-12-01T21:07:42.903Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Value of early intervention in psychosis

Published online by Cambridge University Press:  02 January 2018

R. Manchanda
Affiliation:
University of Western Ontario, London Health Sciences Centre, Victoria Campus, 375 South Street, London, Ontario, Canada N6A 4G5
R. M. Norman
Affiliation:
University of Western Ontario, Prevention & Early Intervention Program for Psychoses (PEPP), London, Ontario, Canada
A. Malla
Affiliation:
McGill University, Montreal, Quebec, Canada
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © 2004 The Royal College of Psychiatrists 

The energy invested in debates about the benefits of early intervention sometimes generates more heat than light, especially when the issue is seen as related to the allocation of resources. The practice of medicine in Canada, while unique, has some parallels to the UK system and so the recent debate (Reference Pelosi and BirchwoodPelosi/Birchwood, 2003) is of considerable interest to us. Although we find ourselves in agreement with Dr Pelosi's concerns about intervention in putative prodromal phases of psychotic illness, the potential value of prompt intervention once psychotic illness has been established seems quite defensible on the grounds of both reducing ongoing suffering and possibly improving long-term outcome. Although the evidence for prompt treatment improving the long-term outcome for psychosis is not irrefutable, there is substantial evidence that such a relation may well exist (Reference Norman and MallaNorman & Malla, 2001; Reference Malla, Norman and ManchandaMalla et al, 2002).

Dr Pelosi implies that first-episode psychosis programmes are elitist and excluded from mainstream psychiatry. Enthusiasm for the early intervention approach need not be to the detriment of other aspects of the mental health system. Our experience is that such programmes increase the public recognition of the need for, and influence the political will to provide, a higher standard of care for people with psychotic disorders. However, we must continue to evaluate whether early intervention with phase-specific pharmacological and psychosocial chosocial interventions reduces the overall burden of chronicity or residual symptoms in these patients.

We have become concerned that the focus on prompt intervention will deflect attention from the need for delivering appropriate interventions - timing is certainly not everything! Early intervention programmes should, in time, also be able to provide information to better identify those likely to have a ‘prolonged recovery’ (Reference Edwards, Maude and McGorryEdwards et al, 1998) or be treatment refractory. This is not the time to turn back, but to move forward and support controlled trials to assess the efficacy of early intervention.

Hopefully, the development of early intervention programmes will result in better linkages between child and adult psychiatry services and also with those involved in long-term care to ensure treatment of psychosis throughout the life cycle and not just for the first 2-3 years. Early intervention programmes are the first steps towards achieving these goals.

References

Edwards, J., Maude, D., McGorry, P. D., et al (1998) Prolonged recovery in first-episode psychosis. British Journal of Psychiatry, 172 (suppl. 33), 107116.Google ScholarPubMed
Malla, A. K., Norman, R. M., Manchanda, R. (2002) Status of patients with first episode psychosis after one year of phase-specific community oriented treatment. Psychiatric Services, 53, 458463.CrossRefGoogle ScholarPubMed
Norman, R. M. & Malla, A. K. (2001) Duration of untreated psychosis: critical examination of the concept and its importance. Psychological Medicine, 31, 381400.CrossRefGoogle ScholarPubMed
Pelosi, A./Birchwood, M. (2003) In debate: Is early intervention for psychosis a waste of valuable resources? British Journal of Psychiatry, 182, 196198.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
3
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Value of early intervention in psychosis
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Value of early intervention in psychosis
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Value of early intervention in psychosis
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *