Article

Early intervention in psychosis: Concepts, evidence and future directions

ORYGEN Research Centre and Department of Psychiatry, and.
World psychiatry: official journal of the World Psychiatric Association (WPA) (Impact Factor: 14.23). 11/2008; 7(3):148-56. DOI: 10.1002/j.2051-5545.2008.tb00182.x
Source: PubMed

ABSTRACT

The rise of the early intervention paradigm in psychotic disorders represents a maturing of the therapeutic approach in psychiatry, as it embraces practical preventive strategies which are firmly established in mainstream health care. Early intervention means better access and systematic early delivery of existing and incremental improvements in knowledge rather than necessarily requiring dramatic and elusive breakthroughs. A clinical staging model has proven useful and may have wider utility in psychiatry. The earliest clinical stages of psychotic disorder are non-specific and multidimensional and overlap phenotypically with the initial stages of other disorders. This implies that treatment should proceed in a stepwise fashion depending upon safety, response and progression. Withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care. While early intervention in psychosis has developed strongly in recent years, many countries have made no progress at all, and others have achieved only sparse coverage. The reform process has been substantially evidence-based, arguably more so than other system reforms in mental health. However, while evidence is necessary, it is insufficient. It is also a by-product as well as a catalyst of reform. In early psychosis, we have also seen the evidence-based paradigm misused to frustrate overdue reform. Mental disorders are the chronic diseases of the young, with their onset and maximum impact in late adolescence and early adult life. A broader focus for early intervention would solve many of the second order issues raised by the early psychosis reform process, such as diagnostic uncertainty despite a clear-cut need for care, stigma and engagement, and should be more effective in mobilizing community support. Early intervention represents a vital and challenging project for early adopters in global psychiatry to consider.

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Available from: Eoin Killackey, Mar 08, 2015
    • "Recent years have also seen a focus on posttraumatic stress disorder (PTSD) in persons with psychosis. McGorry et al. (2008) found that 50% of all persons with first-episode psychosis met the criteria for PTSD. Other studies have shown more modest findings, reporting prevalence rates ranging from 11% to 39% (de Bont et al., 2015; Meyer et al., 1999; Mueser et al., 2010). "
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    • "Research findings support a number of key elements of early intervention programs, yet there is variability in their implementation (Catts et al., 2010; Ghio et al., 2012; McGorry et al., 2008; Srihari et al., 2012). Some programs stress the importance of case management, while others focus on medication or social and functional recovery (Garety et al., 2006; Spencer et al., 2001). "
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    • "Corstens & Longden, 2013). One promising approach (Read et al. 2003) is combining trauma-focused therapeutic models (e.g., Herman, 1992; Ross & Halpern, 2009; Bacon & Kennedy, 2014) with treatments that have established effectiveness in alleviating psychotic symptoms (e. g., acceptance and commitment therapy (Gaudiano & Herbert, 2006), cognitive therapy (Morrison et al. 2014), compassion-focused therapy (Braehler et al. 2013), early intervention strategies (McGorry et al. 2008) and Open Dialogue (Seikkula et al. 2011)). "
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