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Is early intervention in psychosis effective?

Published online by Cambridge University Press:  11 April 2011

Angelo Ricciardi
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, Kings College, University of London, London (United Kingdom) Croydon COAST Early Intervention Service, South London & Maudsley NHS Foundation Trust, London (United Kingdom)
Victoria McAllister
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, Kings College, University of London, London (United Kingdom)
Paola Dazzan
Affiliation:
Division of Psychological Medicine, Institute of Psychiatry, Kings College, University of London, London (United Kingdom) Croydon COAST Early Intervention Service, South London & Maudsley NHS Foundation Trust, London (United Kingdom)

Summary

Aims – Psychosis is a traumatic experience for both sufferers and their families. The morbidity and mortality associated with psychosis may be improved by an assertive, specialised, multidisciplinary approach to care, provided at the earliest opportunity. Early Intervention in Psychosis (EIP) uses such approach to improve the individual's short and long-term symptomatic and functional outcome, as well as quality of life. However, there is still controversy about whether this type of intervention is effective enough to justify its associated costs. Methods – We reviewed evidence from the literature on EIP for schizophrenia spectrum and non-affective psychoses, with particular attention to evidence on its effectiveness in reducing the duration of untreated symptoms, preventing relapses and reducing admission rates, reducing suicide rates, and reducing treatment costs. Results – There is preliminary evidence that EIP may be effective in delaying transition to psychosis, reducing DUP, preventing relapses, reducing admission and suicidal rates, and reducing treatment costs. Discussion – EIP remains a stimulating multidisciplinary approach to psychosis and a demanding commitment for mental health professionals and service developers.

Declaration of Interest: None.

Type
Special Articles
Copyright
Copyright © Cambridge University Press 2008

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References

Addington, J., Williams, J., Young, J. & Addington, D. (2004). Suicidal behaviour in early psychosis. Acta Psychiatrica Scandinavica 109, 116120.CrossRefGoogle ScholarPubMed
Addington, J., Collins, A., McCleery, A. & Addington, D. (2005). The role of family work in early psychosis. Schizophrenia Research 79, 7783.CrossRefGoogle ScholarPubMed
Agius, M., Shah, S., Ramkisson, R., Murphy, S. & Zaman, R. (2007). Three year outcomes of an early intervention for psychosis service as compared with treatment as usual for first psychotic episodes in a standard community mental health team – final results. Psychiatria Danubina 19, 130138.Google Scholar
Arseneault, L., Cannon, M., Poulton, R., Murray, R., Caspi, A. & Moffitt, T.E. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 23, 12121213.CrossRefGoogle Scholar
Birchwood, M. & MacMillan, J.F. (1993). Early intervention in schizophrenia. Australian and New Zealand Journal of Psychiatry 27, 374378.CrossRefGoogle ScholarPubMed
Birchwood, M. & Spencer, E. (2001). Early intervention in psychotic relapse. Clinical Psychology Review 21, 12111226.CrossRefGoogle ScholarPubMed
Borgmann-Winter, K., Calkins, M.E., Kniele, K. & Gur, R.E. (2006). Assessment of adolescents at risk for psychosis. Current Psychiatry Reports 8, 313321.CrossRefGoogle ScholarPubMed
Bryden, K.E., Gardner, D.M. & Kopala, L.C. (2003). First episode psychosis: early intervention strategies with second-generation antipsychotic medications. International Journal of Clinical Practice 57, 513518.CrossRefGoogle ScholarPubMed
Brown, S., Inskip, H. & Barraclough, B. (2000). Causes of excess mortality of schizophrenia. British Journal of Psychiatry 177, 212217.CrossRefGoogle ScholarPubMed
Cannon, T.D., Cadenhead, K., Cornblatt, B., Woods, S.W., Addington, J., Walker, E., Seidman, L.J., Perkins, D., Tsuang, M., McGlashan, T. & Heinssen, R. (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.CrossRefGoogle ScholarPubMed
Cannon-Spoor, H.E., Potkin, S.G. & Wyatt, R.J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.CrossRefGoogle ScholarPubMed
Carbone, S., Harrigan, S., MCGorry, P.D., Curry, C. & Elkins, K. (1999). Duration of untreated psychosis and 12-month outcome in firstepisode psychosis: the impact of treatment approach. Acta Psychiatrica Scandinavica 100, 96104.CrossRefGoogle ScholarPubMed
Clarke, M. & O'Callaghan, E. (2003). Is earlier better? At the beginning of schizophrenia: timing and opportunities for early intervention. Psychiatric Clinics North America 26, 6583.CrossRefGoogle ScholarPubMed
Cornblatt, B.A. (2002). The New York high risk project to the Hillside recognition and prevention (RAP) program. American Journal of Medical Genetics 114, 956966.CrossRefGoogle Scholar
Cornblatt, B.A. & Auther, A.M. (2005). Treating early psychosis: who, what, and when? Dialogues in Clinical Neurosciences 7, 3949.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, 1067.CrossRefGoogle ScholarPubMed
Cullberg, J., Levander, S., Holmqvist, R., Mattsson, M. & Wieselgren, I.M. (2002). One-year outcome in first episode psychosis patients in the Swedish Parachute project. Acta Psychiatrica Scandinavica 106, 276285.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. Acta Psychiatrica Scandinavica 114, 274281.CrossRefGoogle ScholarPubMed
Edwards, J. & McGorry, P.D. (2002). Implementing Early Intervention in Psychosis. Martin Dunitz: London.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
Goldberg, K., Norman, R., Hoch, J.S., Schmitz, N., Windell, D., Brown, N. & Malla, A. (2006). Impact of a specialised earlt intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area. Canadian Journal of Psychiatry 51, 895903.CrossRefGoogle Scholar
Green, T. (2007). The Kraepelinian dichotomy: the twin pillars crumbling? History of Psychiatry 18, 361379.CrossRefGoogle Scholar
Häfner, H. & Nowotny, B. (1995). Epidemiology of early-onset schizophrenia. European. Archives of Psychiatry and Clinical Neuroscience 245, 8092.CrossRefGoogle Scholar
Häfner, H., Riecher-Rossler, A. & Hambrecht, M. (1992). IRAOS: An instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209223.CrossRefGoogle ScholarPubMed
Häfner, H., Maurer, K., Ruhrmann, S., Bechdolf, A., Klosterkötter, J., Wagner, M., Maier, W., Bottlender, R., Möller, H.J., Gaebel, W. & Wölwer, W. (2004). Early detection and secondary prevention of psychosis: facts and visions. European Archives of Psychiatry and Clinical Neuroscience 254, 117128.CrossRefGoogle ScholarPubMed
Hambrecht, M. & Häfner, H. (2000). Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Australian and New Zealand Journal of Psychiatry 34, 468475.CrossRefGoogle ScholarPubMed
Harkavy-Friedman, J.M. (2006). Can early detection of psychosis prevent suicidal behaviour? American Journal of Psychiatry 163, 768770.CrossRefGoogle Scholar
Joa, I., Johannessen, J.O., Auestad, B., Friis, S., McGlashan, T., Melle, I., Opjordsmoen, S., Simonsen, E., Vaglum, P. & Larsen, T.K. (2008). The key to reducing duration of untreated first psychosis: information campaigns. Schizophrenia Bulletin 34, 466472.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 187, Suppl. 48, 2428.CrossRefGoogle Scholar
Kelly, M., O'Meara, Howard A. & Smith, J. (2007). Early intervention in psychosis: a rural perspective. Journal of Psychiatric and Mental Health Nursing 14, 203208.CrossRefGoogle ScholarPubMed
Killackey, E. & Yung, A.R. (2007). Effectiveness of early intervention in psychosis. Current Opinion in Psychiatry 20, 121125.CrossRefGoogle ScholarPubMed
Klosterkotter, J., Ebel, H., Schultze-Lutter, F. & Steinmeyer, E.M. (1996). Diagnostic validity of basic symptoms. European Archives of Psychiatry and Clinical Neuroscience 246, 147154.CrossRefGoogle ScholarPubMed
Kraepelin, E. & Lange, J. (1927). Psychiatrie, 9th ed., Vol. I. J.A. Barth: Leipzig.Google Scholar
Larsen, T.K, Friis, S., Haahr, 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, 323334.CrossRefGoogle ScholarPubMed
Malla, A. & Payne, J. (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin 31, 650671.CrossRefGoogle ScholarPubMed
Malla, A.K., Norman, R.M. & Joober, R. (2005). First-episode psychosis, early intervention, and outcome: what have we learned? Canadian Journal of Psychiatry 50, 881891.CrossRefGoogle ScholarPubMed
Marshall, M. & Rathbone, J. (2006). Early intervention for psychosis. Cochrane Database of Systematic Reviews 18, CD004718.Google 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
McCrone, P. & Knapp, M. (2007). Economic evaluation of early intervention services. British Journal of Psychiatry 191, Suppl. 51, 1922.CrossRefGoogle Scholar
McGlashan, T.H. (1996). Early detection and intervention in schizophrenia: research. Schizophrenia Bulletin 22, 327345.CrossRefGoogle ScholarPubMed
McGlashan, T.H. (1999). Duration of untreated psychosis in firstepisode schizophrenia: marker or determinant of course? Biological Psychiatry 46, 899907.CrossRefGoogle ScholarPubMed
McGlashan, T.H., Miller, T.J., Woods, S.W., Hoffmam, R.E. & Davidson, L. (2001). A scale for the assessment of prodromal symptoms and states. In Early Intervention in Psychotic Disorders (ed. Miller, T.J., Mednick, S.A., McGlashan, T.H., Libiger, J., Johannessen, J.A.), pp. 135150. Kluwer Academic Publishers: Dordrecht.CrossRefGoogle Scholar
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. (1998). “A stitch in time” … the scope for preventive strategies in early psychosis. European Archives of Psychiatry and Clinical Neuroscience 248, 2231.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.D., Yung, A.R. & Phillips, L.J. (2003). The “close-in” or ultra high-risk model: a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder. Schizophrenia Bulletin 29, 771790.CrossRefGoogle ScholarPubMed
McGorry, P.D., Killackey, E. & Yung, A.R. (2007). Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Medical Journal of Australia 7, Suppl. 187, 810.Google Scholar
Melle, I., Larsen, T.K., Haahr, U., Friis, S., Johannessen, J.O., Opjordsmoen, S., Simonsen, E., Rund, B.R., 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
Mihalopoulos, C., Harris, M.G., Henry, L.P. et al. (2007). Are the shortterm cost savings and benefits of an early psychosis program maintained at 8 year follow-up? Eleventh International Congress of Schizophrenia Research; Mar 28-Apr1; Colorado Springs, USA.Schizophrenia Bulletin 33, 203631.Google Scholar
Miller, T.J., McGlashan, T.H., Rosen, J.L., Cannon, T.D., Ventura, J., Cadenhead, K., McFarlane, W., Perkins, D.O., Pearlso, G.D. & Woods, S.W. (2004). Prodromal assessment using the SIPS and SOPS. Schizophrenia Research 1, Suppl. 70, 74.Google Scholar
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
Morrison, A.P., French, P., Parker, S., Roberts, M., Stevens, H., Bentall, R.P. & Lewis, S.W. (2007). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin 33, 682687.CrossRefGoogle Scholar
Nordentoft, M., Jeppesen, P., Abel, M., Kassow, P., Petersen, L., Thorup, A., Krarup, G., Hemmingsen, R. & Jørgensen, P. (2002). OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. One-year follow-up of a randomised controlled trial. British Journal of Psychiatry 181, Suppl. 43, 98106.CrossRefGoogle Scholar
Nordentoft, M., Thorup, A., Petersen, L., Ohlenschlaeger, J., Melau, M., Christensen, T.Ø., Krarup, G., Jørgensen, 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 ScholarPubMed
Norman, R.M., Lewis, S.W. & Marshall, M. (2005). Duration of untreated psychosis and its relationship to clinical outcome. British Journal of Psychiatry 187, Suppl. 48, 1923.CrossRefGoogle Scholar
Patton, G.C., Hetrick, S.E. & McGorry, P. (2007). Service responses for youth onset mental disorders. Current Opinion in Psychiatry 20, 319324.CrossRefGoogle ScholarPubMed
Pelosi, A.J. & Birchwood, M. (2003). Is early intervention for psychosis a waste of valuable resources? British Journal of Psychology 182, 196198.CrossRefGoogle ScholarPubMed
Perkins, D.O., Gu, H., Boteva, K. & Lieberman, J.A. (2005). Relationship between duration of untreated psychosis and outcome in firstepisode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.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
Power, P., Iacoponi, E., Reynolds, N., Fisher, H., Russell, M., Garety, P., McGuire, P.K. & Craig, T. (2007). The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis. British Journal of Psychiatry 191, Suppl. 51, 133139.CrossRefGoogle Scholar
Robinson, D.G., Woerner, M.G., McMeniman, M., Mendelowitz, A. & Bilder, R.M. (2004). Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry 161, 473479.CrossRefGoogle ScholarPubMed
Ruhrmann, S., Schultze-Lutter, F., Maier, W. & Klosterkötter, J. (2005). Pharmacological intervention in the initial prodromal phase of psychosis. European Psychiatry 20, 16.CrossRefGoogle ScholarPubMed
Schaffner, K.F. & McGorry, P.D. (2001). Preventing severe mental illnesses – new prospects and ethical challenges. Schizophrenia Research 51, 315.CrossRefGoogle ScholarPubMed
Schomerus, G. & Angermeyer, M.C. (2008). Stigma and its impact on help-seeking for mental disorders: what do we know? Epidemiologia e Psichiatria Sociale 17, 3137.CrossRefGoogle ScholarPubMed
Singh, S.P. (2007). Outcome measures in early psychosis; relevance of duration of untreated psychosis. British Journal of Psychiatry 191, Suppl. 50, 5863.CrossRefGoogle Scholar
Sipos, A., Harrison, G., Gunnell, D., Amin, S. & Singh, S.P. (2001). Patterns and predictors of hospitalisation in first-episode psychosis – Prospective cohort study. British Journal of Psychiatry 178, 518523.CrossRefGoogle ScholarPubMed
Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care. Epidemiologia e Psichiatria Sociale 17, 1419.CrossRefGoogle ScholarPubMed
Turner, M., Nightingale, S., Smith-Hamel, C. & Mulder, R. (2004). Early intervention for psychosis in New Zealand. New Zealand Medical Journal 117(Aug 6), 1199.Google ScholarPubMed
Tyrer, P. & Johnson, T. (1996). Establishing the severity of personality disorder. American Journal of Psychiatry 153, 15931597.Google ScholarPubMed
Verdoux, H., Liraud, F., Gonzales, B., Assens, F., Abalan, F. & van Os, J. (2001). Predictors and outcome characteristics associated with suicidal behaviour in early psychosis: a two-year follow-up of first-admitted subjects. Acta Psychiatrica Scandinavica 103, 347354.CrossRefGoogle ScholarPubMed
Wyatt, R.J. & Henter, I. (2001). Rationale for the study of early intervention. Schizophrenia Research 51, 6976.CrossRefGoogle 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, 799805.CrossRefGoogle ScholarPubMed
Yung, A.R., McGorry, P.D., McFarlane, C.A., Jackson, H.J., Patton, G.C. & Rakkar, A. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283303.CrossRefGoogle ScholarPubMed
Yung, A.R., Phillips, L.J., Yuen, H.P., Francey, S.M., McFarlane, C.A., Hallgren, M. & McGorry, P.D. (2003). Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophrenia Research 60, 2132.CrossRefGoogle ScholarPubMed