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Early intervention in schizophrenia: Current and future perspectives

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Abstract

The last decade has witnessed an expanding interest in the concept of early intervention (El) in psychotic disorders, notably schizophrenia. This is supported by the well-established association between prolonged untreated illness duration and poor outcome, as well as some evidence of progressive neurobiological changes in the early course of schizophrenia, both in the prepsychotic and psychotic phases as evidenced by brain imaging studies in schizophrenia. Increasingly, mental health service systems around the world have been incorporating specialized El programs. Controlled effectiveness studies in recent years have yielded encouraging data. Several questions in regard to the timing, choice of interventions, and the populations most likely to benefit from Els still remain. More evidence-based data are needed to place the El models in schizophrenia on firm footing in order to effectively implement them in the resource-strapped community mental health service settings.

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References and Recommended Reading

  1. Perkins DO, Gu H, Boteva K, et al.: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005, 162:1785–1804.

    Article  PubMed  Google Scholar 

  2. Marshall M, Lewis S, Lockwood A, et al.: Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005, 62:975–983.

    Article  PubMed  Google Scholar 

  3. Thompson PM, Vidal C, Giedd JN, et al.: Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A 2001, 98:11650–11655.

    Article  PubMed  CAS  Google Scholar 

  4. Pantelis C, Velakoulis D, McGorry PD, et al.: Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet 2003, 361:281–288.

    Article  PubMed  Google Scholar 

  5. Wyatt RJ: Neuroleptics and the natural course of schizophrenia. Schizophr Bull 1991, 17:325–351.

    PubMed  CAS  Google Scholar 

  6. Yung AR, Phillips LJ, McGorry PD: Treating Schizophrenia in the Prodromal Stage. London: Taylor & Francis; 2004.

    Google Scholar 

  7. Yung AR, Yuen HP, Berger G, et al.: Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 2007 [Epub ahead of print].

  8. Pukrop R, Schultze-Lutter F, Ruhrmann S, et al.: Neurocognitive functioning in subjects at risk for a first episode of psychosis compared with first-and multiple-episode schizophrenia. J Clin Exp Neuropsychol 2006, 28:1388–1407.

    Article  PubMed  Google Scholar 

  9. McGorry PD, Hickie IB, Yung AR, et al.: Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry 2006, 40:616–622.

    Article  PubMed  Google Scholar 

  10. Keefe RS, Seidman LJ, Christensen BK, et al.: Comparative effect of atypical and conventional antipsychotic drugs on neurocognition in first-episode psychosis: a randomized, double-blind trial of olanzapine versus low doses of haloperidol. Am J Psychiatry 2004, 161:985–995.

    Article  PubMed  Google Scholar 

  11. McGorry PD, Yung AR, Phillips LJ, et al.: Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002, 59:921–928.

    Article  PubMed  Google Scholar 

  12. McGlashan TH, Zipursky RB, Perkins D, et al.: Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006, 163:790–799.

    Article  PubMed  Google Scholar 

  13. Nordentoft M, Thorup A, Petersen L, et al.: 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. Schizophr Res 2006, 83:29–40.

    Article  PubMed  Google Scholar 

  14. Morrison AP, French P, Walford L, et al.: Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004, 185:291–297.

    Article  PubMed  Google Scholar 

  15. Cornblatt BA, Lencz T, Kane JM: Treatment of the schizophrenia prodrome: is it presently ethical? Schizophr Res 2001, 51:31–38.

    Article  PubMed  CAS  Google Scholar 

  16. Ohlsen RI, O’Toole MS, Purvis RG, et al.: Clinical effectiveness in first-episode patients. Eur Neuropsychopharmacol 2004, 14(Suppl 4):S445–S451.

    Article  PubMed  CAS  Google Scholar 

  17. Lieberman JA, Stroup TS, McEvoy JP, et al.: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005, 353:1209–1223.

    Article  PubMed  CAS  Google Scholar 

  18. Jones PB, Barnes TR, Davies L, et al.: Randomized controlled trial of the effect on Quality of Life of second-vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006, 63:1079–1087.

    Article  PubMed  CAS  Google Scholar 

  19. Hogarty GE, Flesher S, Ulrich R, et al.: Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry 2004, 61:866–876.

    Article  PubMed  Google Scholar 

  20. Petersen L, Jeppesen P, Thorup A, et al.: A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. BMJ 2005, 331:602.

    Article  PubMed  Google Scholar 

  21. Linszen D, Dingemans P, Lenior M: Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications. Schizophr Res 2001, 51:55–61.

    Article  PubMed  CAS  Google Scholar 

  22. Marshall M, Rathbone J: Early intervention for psychosis. Cochrane Database Syst Rev 2006, 4:CD004718.

  23. Blyler CR: Commentary: Service system perspectives on early intervention research. Schizophr Bull 2003, 29:867–875.

    PubMed  Google Scholar 

  24. Pelosi AJ, Birchwood M: Is early intervention for psychosis a waste of valuable resources? Br J Psychiatry 2003, 182:196–198.

    Article  PubMed  Google Scholar 

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Correspondence to Matcheri S. Keshavan MD.

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Keshavan, M.S., Amirsadri, A. Early intervention in schizophrenia: Current and future perspectives. Curr Psychiatry Rep 9, 325–328 (2007). https://doi.org/10.1007/s11920-007-0040-8

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