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Disease Management and Health Outcomes

, Volume 9, Issue 6, pp 317–327 | Cite as

Early Recognition and Intervention

The Key to Success in the Treatment of Schizophrenia?
  • Jan Olav Johannessen
Review Article

Abstract

Schizophrenia is possibly the single most costly disorder in psychiatric or somatic medicine, despite a relatively low yearly incidence of about 10/100 000/ year. In many cases it is a life-long disabling disorder. Available treatments, including medication, psychotherapy and family treatments are largely palliative and seem to be of only limited value. This may be due to an apparent delay in providing treatment early in the course of the illness.

Schizophrenia can be regarded as a disorder that develops in stages: premorbid, prodromal and psychotic. Research over the last few years indicates that early treatment for schizophrenia may improve the course of the disorder.

Projects aimed at intervening in the prodromal phase of the disorder have shown that it may be possible to reduce the incidence in a catchment area (Buckingham, UK), or prevent the conversion of prodromal cases into fulminate psychosis (Melbourne, Australia).

In Norway, the Early Treatment and Intervention in Psychosis (TIPS) project demonstrated that it was possible to reduce the duration of untreated psychosis within a catchment area from a mean of 114 weeks to 26 weeks, and thus dramatically reduce the total period of psychosis. There are also indications that earlier detection results in patients who present with less severe psychopathology.

Earlier detection is possible through information campaigns which enhance the public’s knowledge about serious psychiatric disorders, and aim to reduce the stigma associated with this disorder and change help-seeking behavior. Earlier intervention requires easy access to psychiatric health services, and early, comprehensive treatment programs.

Early detection and intervention can be managed successfully ensuring patients are provided with treatment at an earlier point in the development of the illness. Such programs are relatively inexpensive, since it is a question of organizing the health services in a way that meets the population’s needs.

Keywords

Schizophrenia Assertive Community Treatment Brief Psychiatric Rate Scale Prodromal Symptom Early Psychosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Mednick S, McGlashan T. Early detection and intervention with psychosis: opportunities for preventing chronicity. New Haven: NATO International Scientific Exchange Programmes. Advanced Study Institute 1996: 1–10Google Scholar
  2. 2.
    Andreasen NC. Assessment issues and the cost of schizophrenia. Schizophr Bull 1991; 17: 351–72Google Scholar
  3. 3.
    Murray CJL, Lopez AD. The global burden of disease. World Health Organization, Harvard School of Public Health, World Bank. Geneva: Harvard University Press, 1996Google Scholar
  4. 4.
    Johannessen JO. The epidemiology of schizophrenia in a Norwegian county. Nord J Psychiatry 1985; 39: 217–3CrossRefGoogle Scholar
  5. 5.
    McGlashan TH. Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Soc Biol Psychiatry 1999; 46: 899–907CrossRefGoogle Scholar
  6. 6.
    McGorry PD, Krstev H, Harrigan S. Early detection and treatment delay: implications in early psychosis. Curr Opion Psychiatry 2000; 13: 37–43CrossRefGoogle Scholar
  7. 7.
    Johannessen JO, Larsen TK, McGlashan TH. Duration of untreated psychosis: an important target for intervention in schizophrenia? Nord J Psychiatry 1999; 53: 275–83CrossRefGoogle Scholar
  8. 8.
    van Os J, Gilvarry C, Bale R, et al. A comparison of the utility of dimensional and categorical representations of psychosis. Eur Psychiatry 2000; 15 Suppl. 2: 286Google Scholar
  9. 9.
    McGuire PK, Dixon TA. Psychosis is better described as a continuum, rather than as categories. Eur Psychiatry 2000; 15 Suppl. 2: 286CrossRefGoogle Scholar
  10. 10.
    Sullivan HS. The onset of schizophrenia. Am J Psychiatry 1994 Jun; 151 Suppl. 6: 134–9PubMedGoogle Scholar
  11. 11.
    Mrazek PJ, Haggerty RJ. Reducing risk for mental disorder: frontiers of preventive intervention research. Committee on Prevention of Mental Disorders, Institute of Medicine. Washington, DC: National Academy Press, 1994Google Scholar
  12. 12.
    McGlashan TH, Johannessen JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull 1996; 22: 201–2PubMedCrossRefGoogle Scholar
  13. 13.
    Wyatt RJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull 1991; 17: 325–51PubMedCrossRefGoogle Scholar
  14. 14.
    Hogarty GE, Anderson CM, Reiss DJ. Family education, social skills, training and maintenance chemotherapy in the aftercare of schizophrenia. Arch Gen Psychiatry 1986; 43: 633–42PubMedCrossRefGoogle Scholar
  15. 15.
    Birchwood M. Early intervention in schizophrenia: theoretical background and clinical strategies. Br J Psychiatry 1992; 31: 257–78CrossRefGoogle Scholar
  16. 16.
    Leff JP. Stress reduction in the social environment of schizophrenic patients. Acta Psychiatr Scand 1994; Suppl. 384: 133–9CrossRefGoogle Scholar
  17. 17.
    Kissling W. Compliance, quality assurance and standards for relapse prevention in schizophrenia. Acta Psychiatr Scand 1994; 89 Suppl. 382: 16–24CrossRefGoogle Scholar
  18. 18.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1997Google Scholar
  19. 19.
    World Health Organization. International classification of diseases. 10th ed. Mental and behavioural disorders. Geneva: World Health Organization, 1992Google Scholar
  20. 20.
    Häfner H, Löffler W, Maurer K, et al. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand 1999; 100: 105–8PubMedCrossRefGoogle Scholar
  21. 21.
    Olin SS, Mednick SA. Risk factors of psychosis; identifying vulnerable populations premorbidly. Schizophr Bull 1996; 22(2): 223–40PubMedCrossRefGoogle Scholar
  22. 22.
    Jones PB. Population birth cohorts: antecedents of schizophrenia. Eur Psychiatry 2000; 15 Suppl. 2: 213CrossRefGoogle Scholar
  23. 23.
    Falloon IRH. Early intervention for first episode of schizophrenia: a preliminary exploration. Psychiatry 1992; 55: 4–14PubMedGoogle Scholar
  24. 24.
    American Psychiatric Association. DSM-III-R: diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  25. 25.
    Shepherd M, Watt D, Faloon IRH, et al. The natural history of schizophrenia. Psychological Medicine Monograph 16. Cambridge: Cambridge University Press, 1989Google Scholar
  26. 26.
    Larsen TK, Opjordsmoen S. Early identification and treatment of schizophrenia: conceptual and ethical considerations. Psychiatry 1996; 59: 371–80PubMedGoogle Scholar
  27. 27.
    Yung AL, Phillips LA, McGorry PD, et al. Prediction of psychosis. Br J Psychiatry 1998; 172 Suppl. 33: 14–20Google Scholar
  28. 28.
    Overall JE, Gorham DR. The Brief psychiatric rating scale. Psychol Rep 1962; 10: 799–812CrossRefGoogle Scholar
  29. 29.
    McGorry PD, Phillips LJ, Yung AR, et al. A randomised controlled trial of interventions in the pre-psychotic phase of psychotic disorders. Schiz Res 2000; 41(1): 9CrossRefGoogle Scholar
  30. 30.
    Klosterkötter J, Steinmeyer EM, Schultze-Lutter F. The Cologne early recognition project [late abstracts]. Eur Psychiatry 2000; 15: 14Google Scholar
  31. 31.
    Johnstone EC, MacMillan J, Crow T, et al. The Northwich Park First Episodes of Schizophrenia. III. Short-term outcome in trial entrants and trial eligible patients. Br J Psychiatry 1986; 148: 128–33PubMedCrossRefGoogle Scholar
  32. 32.
    Loebel AD, Lieberman JA, Alvir JMJ, et al. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 1992; 149: 1183–8PubMedGoogle Scholar
  33. 33.
    Haas GL, Sweeney JA. Premorbid and onset features of first episode schizophrenia. Schizophr Bull 1992; 18: 373–86PubMedCrossRefGoogle Scholar
  34. 34.
    Beiser M, Erickson D, Fleming JAE, et al. Establishing the onset of psychotic illness. Am J Psychiatry 1999; 150: 1349–54Google Scholar
  35. 35.
    Larsen TK, McGlashan TH, Moe LC. First-episode schizophrenia: I. early course parameters. Schizophr Bull 1996; 22(2): 241–56PubMedCrossRefGoogle Scholar
  36. 36.
    Birchwood M. Prodromes of relapse and first-episode of psychoses: different or same? Eur Psychiatry 2000; 15 Suppl. 2: 316CrossRefGoogle Scholar
  37. 37.
    Johannessen JO, Larsen TK, McGlashan T, et al. Early intervention in psychosis: the TIPS project, a multi-centre study in Scandinavia. In: Martindale B, Bateman A, Crowe M, et al., editors. Psychosis — psychological approaches and their effectiveness. Glasgow: Gaskell, 2000: 210–34Google Scholar
  38. 38.
    Larsen TK, Johannessen JO, McGlashan T, et al. Can duration of untreated psychosis be reduced? In: Birchwood M, Fowler D, Jackson C, editors. Early intervention in psychosis. Chichester: John Wiley & Sons Ltd, 2000: 143–65Google Scholar
  39. 39.
    Jorm AF. Mental health literacy. Br J Psychiatry 2000; 177: 396–401PubMedCrossRefGoogle Scholar
  40. 40.
    Søgaard AJ, Fønnebø V. The Norwegian Mental Health Campaign in 1992. Part II; changes in knowledge and attitudes. Health Educ Res 1992; 10(3): 267–78CrossRefGoogle Scholar
  41. 41.
    US Department of Health and Human Services. Predictive tobacco use among young people. A report of the surgeon general. Atlantic: Center for Disease Control and Prevention, 1994Google Scholar
  42. 42.
    Johannessen JO, McGlashan TH, Larsen TK, et al. Early detection strategies for untreated first episode psychosis. Schizophr Res. In pressGoogle Scholar
  43. 43.
    Larsen TK, Johannessen JO, Guldberg C, et al. Early intervention programs in first-episode psychosis and reduction of duration of untreated psychosis (DUP). Schizophr Res 1999; 36: 344–5Google Scholar
  44. 44.
    Friis S, Melle I, Haahr U, et al. Threats to validity in outcome studies of early intervention in schizophrenia. Schizophr Res 1999; 36: 340Google Scholar
  45. 45.
    Verdoux H, Bergey C, Assens F, et al. Prediction of duration of psychosis before first admission. Eur Psychiatry 1998; 13: 346–52PubMedCrossRefGoogle Scholar
  46. 46.
    Barnes TRE, Hutton SB, Chapman MJ, et al. West London first-episode of schizophrenia. Br J Psychiatry 2000; 177: 207–11PubMedCrossRefGoogle Scholar
  47. 47.
    Ho BC, Andreasen NC, Flaum M, et al. Untreated initial psychosis: its relationship to quality of life and symptom remission in first-episode schizophrenia. Am J Psychiarty 2000; 157(5): 808–15CrossRefGoogle Scholar
  48. 48.
    McGorry PD, Edwars J, Mihalopoulos C, et al. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22(2): 305–26PubMedCrossRefGoogle Scholar
  49. 49.
    Robinson D, Woerner M, Alvir J, et al. Predictors of treatment response from a first-episode of schizophrenia of schizoaffective disorder. Am J Psychiatry 1999; 156: 544–9PubMedGoogle Scholar
  50. 50.
    Sanger T, Lieberman J, Tohen M, et al. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156: 79–87PubMedGoogle Scholar
  51. 51.
    Remington G, Kapur S, Zipursky R. Pharmacotherapy of fistepisode schizophrenia. Br J Psychiatry 1998; 172 Suppl. 33: 66–70Google Scholar
  52. 52.
    McGorry P, Edwards J. The feasibility and effectiveness of early intervention in psychotic disorder: the Australian experience. Int Clin Psychopharmacol 1998; 13 Suppl. 1: 47–52CrossRefGoogle Scholar
  53. 53.
    Olin SCS, Mednick SA, Cannon T, et al. School teacher ratings predictive of psychiatric outcome 25 years later. Br J Psychiatry 1998; 172 Suppl. 33: 7–13Google Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Rogaland Psychiatric ServicesStavangerNorway

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