Early Intervention in Schizophrenia

Abstract

The management of schizophrenia may be characterised by two paradigms. The first approaches the schizophrenias as episodic relapsing disorders, where treatment is provided through both acute (crisis) care and to achieve prophylaxis. The second paradigm, sometimes arising from a failure of the first, is of "rehabilitation", involving amelioration of disabilities, occasionally within a framework of relative asylum. We would propose a third paradigm of "early intervention", involving a combination of medical and psychosocial interventions targeted at young, vulnerable people with the aim of preventing or limiting likely social, psychological and mental deterioration. Vigorous intervention early in the course of illness, early recognition and treatment of relapse and the promotion of psychological adjustment to psychotic illness are proposed as key elements of this third paradigm.

Neurocognitive functioning in patients with first-episode schizophrenia 1 year from onset in comparison with patients 5 years from onset

“…It has been reported that patients with schizophrenia tend to have a high risk of relapse and social dysfunction during the fi rst 5 years of the onset of the disease, named the " Unstable period " (Utena 1991). Based on these fi ndings, it is reasonable to speculate that the majority of biological, psychological, and social changes occur during this 5-year period (Birchwood et al 1997). A SOHO study that compared the eff ects of different antipsychotics on outpatients with schizophrenia in Europe concluded that 38.2% of the patients had achieved remission at the fi rst year follow-up, 64.6% had achieved remission 3 years aft er onset, and that shorter durations of mental disorders increased the rate of remission (Haro et al 2006).…”

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

“…A systematic review and meta-analysis of longitudinal studies (C12-month follow-up), with at least 80 % of first-episode patients, found that medication non-adherence (defined according to the criteria employed in the individual studies) increased the risk for relapse 4-fold (odds ratio [OR] 4.09; 95 % CI 2.55-6.56; p \ 0.01) [4]. On the other hand, outcome in first-episode patients can be improved by being adherent to long-term treatment [5], particularly when treatment is started during the period immediately after the first episode (also called 'the critical period') [6][7][8][9]. To prevent relapse in patients with schizophrenia, the World Federation of Societies of Biological Psychiatry (WFSBP), following evidence-based clinical guidelines such as the Schizophrenia Patient Outcomes Research Team (PORT) recommendations [10], therefore strongly recommends continuous antipsychotic treatment once patients are stabilized [11].…”

Beyond the first episode: Candidate factors for a risk prediction model of schizophrenia

“…The rationale behind the development of early intervention services for first episode psychosis (FEP) has been well described (Birchwood, McGorry, & Jackson, 1997;Birchwood, Todd, & Jackson, 1998;McGorry, 1998;Petersen et al, 2005). They are more effective than standard care in improving outcomes (Craig et al, 2004;Petersen et al, 2005) and there is some support for cost effectiveness McGorry, Killackey, & Yung, 2007;Mihalopoulos, McGorry, & Carter, 1999).…”