Early Psychosis, Schizophrenia and the Family

Abstract

Schizophrenia remains the most severe psychotic disorder and a source of intense distress for the family. With the typical onset of the first psychotic episode of schizophrenia in adolescence or early adulthood the productive years of young people are interrupted. When parents generally expect their children to become adult and independent, deterioration of functioning starts, even before the first psychotic episode (Jones et al., 1993; Häfner et al., 1995). Precisely in this period the severity of schizophrenia will be established, i.e. in the early phase 5 years after the first psychotic episode (Bleuler, 1978; McGlashan, 1996). Eighty percent of people with first episode schizophrenia or related disorders relapse at least once or more within five years (Sheperd et al., 1989; Robinson et al., 1999). There is a decline in social contacts with the peer group, especially in young men with an earlier age of onset than females (mean difference: 5 years, Angermeyer and Kühn, 1988). The early phase of psychosis and schizophrenia can thus be seen as a ‘critical period’ with major implications for the prevention of disease and psychosocial deterioration (Birchwood et al., 1998). Early recognition and intervention may thus lead to a better outcome. Evidence for that idea is based on the following findings: