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Intervention in the prepsychotic phase of schizophrenia and related disorders: towards effective and safe strategies for earliest intervention in psychotic disorders

  • P. D. McGorry
  • A. R. Yung
  • L. J. Phillips

Abstract

In recent years there has been a groundswell of clinical and research interest around the world in early intervention in psychotic disorders (Edwards & McGorry 2002; Malla and Norman 2002). The early psychosis paradigm, which is centred on early detection and optimal treatment of first episode psychosis and the subsequent critical years, has become a sustained growth front in both the clinical and research arenas. This is due to the great potential of this approach, the strong commitment to evidence-based medicine, the quality of the research endeavours, and the close integration of the research and clinical questions. Further progress will depend upon the involvement of an increasing number of clinical and academic centres in this new frontier of research and treatment.

Keywords

Psychotic Disorder First Episode Psychosis Acute Psychosis Early Psychosis Episode 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.

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References

  1. Andreasen N (1982) Negative symptoms in schizophrenia: definition and reality. Archives of General Psychiatry 39:784–788PubMedCrossRefGoogle Scholar
  2. Asarnow JR (1988) Children at risk for schizophrenia: converging lines of evidence. Schizophrenia Bulletin 14:613–630PubMedCrossRefGoogle Scholar
  3. Bechdolf A, Wagner M, Hambrecht M (2002) Psychological intervention in the pre-psychotic phase: preliminary results of a multicentre trial. Acta Psychiatrica Scandinavica 106:41CrossRefGoogle Scholar
  4. Bell RQ (1992) Multiple-risk cohorts and segmenting risk as solutions to the problem of false positives in risk for the major psychoses. Psychiatry 55(4):370–381PubMedGoogle Scholar
  5. Bentall RP, Morrison AP (2002) More harm than good: The case against using antipsy-chotic drugs to prevent severe mental illness. Journal of Mental Health 11:351–356CrossRefGoogle Scholar
  6. Berger GE, Wood S, McGorry PD (2003) Incipient neurovulnerability and neuropro-tection in early psychosis. Psychopharmacology Bulletin 37(2)Google Scholar
  7. Brewer W, Pantelis C, Anderson V, Velakoulis D, Singh B, Copolov DL, McGorry PD (2001) Stability of olfactory identification deficits in neuroleptic-naïve patients with first-episode psychosis. American Journal of Psychiatry 158(1):107–115PubMedCrossRefGoogle Scholar
  8. Buckley PF (1988) The clinical stigmata of aberrant neurodevelopment in schizophrenia. Journal of Nervous and Mental Disease 186:79–86CrossRefGoogle Scholar
  9. Cannon TD, Mednick SA (1993) The schizophrenia high-risk project in Copenhagen: three decades of progress. Acta Psychiatrica Scandinavica 87(Suppl 370):33–47CrossRefGoogle Scholar
  10. Carr V, Halpin S, Lau N, O’Brien S, Beckmann J, Lewin T (2000) A risk factor screening and assessment protocol for schizophrenia and related psychosis. Australian and New Zealand Journal of Psychiatry 34 (Suppl):S170–180PubMedGoogle Scholar
  11. Corcoran C, Gallitano A, Leitman D, Malaspina D (2001) The neurobiology of the stress cascade and its potential relevance for schizophrenia. Journal of Psychiatric Practice 7:3–14PubMedCrossRefGoogle Scholar
  12. Cornblatt B, Lencz T, Correll C, Authour A, Smith C (2002) Treating the prodrome: Naturalistic findings from the RAP Program. Acta Psychiatrica Scandinavica (Suppl) 106:44CrossRefGoogle Scholar
  13. Cornblatt BA (2002) The New York High Risk Project to the Hillside Recognition and Prevention (RAP) Program. American Journal of Medical Genetics (Neuropsychiatric Genetics) 114:956–966CrossRefGoogle Scholar
  14. DeGrazia D (2001) Ethical issues in early-intervention clinical trials involving minors at risk for schizophrenia. Schizophrenia Research 51:77–86PubMedCrossRefGoogle Scholar
  15. Eaton WW (1995) Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. American Journal of Psychiatry 152:967–972PubMedGoogle Scholar
  16. Edwards J, McGorry PD (2002) Implementing early intervention in psychosis: a guide to establishing early psychosis services. Martin Dunitz, LondonGoogle Scholar
  17. Erlenmeyer-Kimling L, Adamo UH, Rock D, Roberts SA, Bassett AS, Squirres-Wheeler E, Cornblatt BA, Endicott J, Pape S, Gottesman II (1997) The New York High-Risk Project: prevalence and comorbidity of Axis I disorders in offspring of schizophrenic parents at 25-year follow-up. Archives of General Psychiatry 54:1096–1102PubMedCrossRefGoogle Scholar
  18. Erlenmeyer-Kimling L, Squires-Wheeler E, Adamo UH, Bassett AS, Cornblatt BA, Kestenbaum CJ, Rock D, Roberts SA, Gottesman II (1995) The New York High Risk Project: psychoses and cluster A personality disorders in offspring of schizophrenic parents at 23 years of follow-up. Archives of General Psychiatry 52:857–865PubMedCrossRefGoogle Scholar
  19. Falloon IRH (1992) Early intervention for first episode of schizophrenia: a preliminary exploration. Psychiatry, 55:4–15PubMedGoogle Scholar
  20. Fish B, Marcus J, Hans SL, Auerbach JG, Perdue S (1992) Infants at risk for schizophrenia: Sequelae of a genetic neurointegrative defect. Archives of General Psychiatry 49:221–235PubMedCrossRefGoogle Scholar
  21. French P (2002) Model-driven psychological intervention to prevent onset of psychosis. Acta Psychiatrica Scandinavica (Suppl) 106:18CrossRefGoogle Scholar
  22. Gross G (1989) The `basic’ symptoms of schizophrenia. British Journal of Psychiatry 155 (suppl 7):21–25Google Scholar
  23. Häfner H, Maurer W, Löffler B, Bustamante S, an der Heiden W, Nowotny B (1995) Onset and early course of schizophrenia. In: Häfner H, Gattaz WF (eds) Search for the Causes of Schizophrenia. Springer, New York, III, pp 43–66CrossRefGoogle Scholar
  24. Heinssen R, Perkins DO, Appelbaum PS, Fenton WS (2001) Informed consent in early psychosis research: National Institute of Mental Health Workshop, November 15, 2000. Schizophrenia Bulletin 27:571–584PubMedCrossRefGoogle Scholar
  25. Hodges A, Byrne M, Grant E, Johnstone E (1999) People at risk of schizophrenia: sample characteristics of the first 100 cases in the Edinburgh high-risk study. British Journal of Psychiatry 174:547–553PubMedCrossRefGoogle Scholar
  26. Ingraham LJ, Kugelmass S, Frenkel E, Nathan M, Mirsky AF (1995) Twenty-five year follow-up of the Israeli High-risk Study: current and lifetime psychopathology. Schizophrenia Bulletin 21:183–192PubMedCrossRefGoogle Scholar
  27. Ismail B, Cantor-Graae E, McNeil TF (1998) Neurological abnormalities in schizo-phrenic patients and their siblings. American Journal of Psychiatry 155:84–89PubMedGoogle Scholar
  28. Johannessen JO, McGlashan TH, Larsen TK, Homeland M, Joa I, Mardal S, Kvebaek R, Friis S, Melle I, Opjordsmoen S, Simonsen E, Ulrik H, Vaglum P (2001) Early detection strategies for untreated first-episode psychosis. Schizophrenia Research 51:39–46PubMedCrossRefGoogle Scholar
  29. Johns L, Broome M, Matthiasson P, Power P, McGuire PK (2002) OASIS: a new service for people with prodromal signs of psychosis. Acta Psychiatrica Scandinavica 106:73Google Scholar
  30. Johnstone EC, Abukmeil SS, Byrne M, Clafferty R, Grant E, Hodges A, Lawrie SM, Owens DGC (2001) Edinburgh high risk study - findings after four years: demographic, attainment and psychopathological issues. Schizophrenia Research 46:1–15CrossRefGoogle Scholar
  31. Jones P (2000) The epidemiology of psychotic disorder. Keynote address at “Future Possible” 2ndInternational Conference on Early Psychosis, New York City, 31 March & 1–2 AprilGoogle Scholar
  32. Jones P, Rodgers B, Murray R, Marmot M (1994) Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344:1398–1402PubMedCrossRefGoogle Scholar
  33. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13:261–269PubMedCrossRefGoogle Scholar
  34. Kendler KS (1986) Genetics of schizophrenia. In: Frances AJ, Hales RE (eds) American Psychiatric Association Annual Review. American Psychiatric Press, Washington DC, p 5Google Scholar
  35. Klosterkötter J, Gross G, Wieneke A, Steinmeyer EM, Schultze-Lutter F (1997a) Evaluation of the ‘Bonn Scale for the Assessment of Basic Symptoms- - BSABS’ as an instrument for the assessment of schizophrenia proneness: a review of recent findings. Neurology, Psychiatry and Brain Research 5:137–150Google Scholar
  36. Klosterkötter J, Schultze-Lutter F, Gross G, Huber G, Steinmeyer EM (1997b) Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study. Acta Psychiatrica Scandinavica 95:396–404CrossRefGoogle Scholar
  37. Klosterkötter, J, Hellmich M, Steinmeyer EM, Schultze-Lutter F (2001) Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry 58:158–164PubMedCrossRefGoogle Scholar
  38. Koehler K, Sauer H (1984) Huber’s basic symptoms: another approach to negative psychopathology in schizophrenia. Comprehensive Psychiatry 25:174–182PubMedCrossRefGoogle Scholar
  39. Krstev H, Carbone S, Harrigan SM, McGorry PD, Curry C, Elkins K (2004) Early intervention in first episode psychosis: the impact of a community development campaign. Social Psychiatr & Psychiatric Epidemiology (in press)Google Scholar
  40. Larsen TK (2002) The transition from the premorbid period to psychosis: how can it be described? Acta Psychiatrica Scandinavica (Suppl) 106:10–11Google Scholar
  41. Lieberman JA, Fenton WS (2000) Delayed detection of psychosis: causes, consequences, and effect on public health. American Journal of Psychiatry 157:1727–1730PubMedCrossRefGoogle Scholar
  42. Malla AK, Norman RMG (2002) Early intervention in schizophrenia and related disorders: advantages and pitfalls. Current Opinion in Psychiatry 15:17–23CrossRefGoogle Scholar
  43. McFarlane WR, Cook WL, Robbins D, Downing D (2002) Portland identification and early referral. Acta Psychiatrica Scandinavica 413:20Google Scholar
  44. McGlashan TH (1999) Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry 47:473Google Scholar
  45. McGlashan TH (2001) Psychosis treatment prior to psychosis onset: ethical issues. Schizophrenia Research 51:47–54PubMedCrossRefGoogle Scholar
  46. McGorry PD (1993) Early psychosis prevention and intervention centre. Australian Psychiatry 1:32–34CrossRefGoogle Scholar
  47. McGorry PD (2002) Early psychosis reform: too fast or too slow? Acta Psychiatrica Scandinavica 106:249–251PubMedCrossRefGoogle Scholar
  48. McGorry PD, Singh BS (1995) Schizophrenia: risk and possibility. In: Raphael B, Burrows GD (eds) Handbook of Studies on Preventive Psychiatry. Elsevier, pp 491–514Google Scholar
  49. McGorry PD, Yung AR (2003) Early intervention in psychosis: an overdue reform.Australian and New Zealand Journal of Psychiatry 37:393–398PubMedCrossRefGoogle Scholar
  50. McGorry PD, Edwards J, Mihalopolous C, Harrigan SM, Jackson HJ (1996) EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22:305–326PubMedCrossRefGoogle Scholar
  51. McGorry PD, Goodwin RJ, Stuart GW (1988) The development, use and reliability of the Brief Psychiatric Rating Scale (Nursing Modification) - an assessment procedure for the nursing team in clinical and research settings. Comprehensive Psychiatry 29:575–587PubMedCrossRefGoogle Scholar
  52. McGorry PD, Yung AR, Phillips LJ (2001) Ethics and early intervention in psychosis: keeping up the pace and staying in step. Schizophrenia Research 51:17–29PubMedCrossRefGoogle Scholar
  53. McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, Germano D, Bravin J, Adlard S, McDonald A, Blair A, Jackson HJ (2002) A 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 59:921–928PubMedCrossRefGoogle Scholar
  54. McGuffin P, Farmer AE, Gottesman M, Murray RM, Reveley AM (1984) Twin concordance for operationally defined schizophrenia. Archives of General Psychiatry 49:541–545CrossRefGoogle Scholar
  55. Meares A (1959) The diagnosis of prepsychotic schizophrenia. Lancet I:55–59CrossRefGoogle Scholar
  56. Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, Woods SW (2002) Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Symptoms: preliminary evidence of inter-rater and predictive validity. American Journal of Psychiatry 159:863–865PubMedCrossRefGoogle Scholar
  57. Miller TJ, McGlashan TH, Woods SW, Stein K, Briesen N, Corcoran CM, Hoffman R, Davidson L (1999) Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly 70:273–287PubMedCrossRefGoogle Scholar
  58. Morrison AP, Bentall RP, French P, Walford L, Kilcommons A, Knight A, Kreutz M, Lewis SW (2002) Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors. British Journal of Psychiatry (Supply 43:s78-s84CrossRefGoogle Scholar
  59. Mrazek PJ, Haggarty RJ (1994) Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. National Academy Press, Washington DCGoogle Scholar
  60. Nagler S (1985) Overall design and methodology of the Israeli High Risk Study. Schizophrenia Bulletin 11:31–37PubMedCrossRefGoogle Scholar
  61. Olin SC, Mednick SA (1996) Risk factors of psychosis: Identifying vulnerable populations premorbidly. Schizophrenia Bulletin 22:223–240PubMedCrossRefGoogle Scholar
  62. O’Reilly RL (1994) Viruses and schizophrenia. Australian and New Zealand Journal of Psychiatry 28:222–228PubMedCrossRefGoogle Scholar
  63. Overall JE, Gorham DR (1962) The Brief Psychiatric Rating Scale. Psychological Reports 10:799–812CrossRefGoogle Scholar
  64. Pantelis C, Velakoulis D, McGorry PD, Wood SJ, Suckling J, Phillips LJ, Yung AR, Bullmore ET, Brewer W, Soulsby B, Desmond P, McGuire PK (2003a) Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet 361(9354):281–288CrossRefGoogle Scholar
  65. Pantelis C, Yücel M, Wood SJ, McGorry PD, Velakoulis D (2003b) Early and late neurodevelopmental disturbances in schizophrenia and their functional consequences. Australian and New Zealand Journal of Psychiatry 37:399–406CrossRefGoogle Scholar
  66. Phillips LJ, Leicester SB, O’Dwyer LE, Francey SM, Koutsogiannis J, Abdel-Baki A, Kelly D, Jones S, Vay C, Yung AR, McGorry PD (2002a) The PACE Clinic: identification and management of young people at `ultra’ high risk of psychosis. Journal of Psychiatric Practice 8:255–269CrossRefGoogle Scholar
  67. Phillips LJ, Velakoulis D, Pantelis C, Yuen HP, Yung AR, Desmond P, Brewer W, McGorry PD (2002b) Non-reduction in hippocampal volume is associated with higher risk of psychosis. Schizophrenia Research 58:145–158CrossRefGoogle Scholar
  68. Phillips LJ, Yung AR, Hearn N, McFarlane CA, Hallgren M, McGorry PD (1999) Preventive mental health care: accessing the target population. Australian and New Zealand Journal of Psychiatry 33:912–917PubMedCrossRefGoogle Scholar
  69. Schaffner KF, McGorry PD (2001) Preventing severe mental illnesses: new prospects and ethical challenges. Schizophrenia Research 51:3–15PubMedCrossRefGoogle Scholar
  70. Sullivan HS (1927) The onset of schizophrenia. American Journal of Psychiatry 6:105–134Google Scholar
  71. Tien AY, Costa PT, Eaton WW (1992) Covariance of personality, neurocognition, and schizophrenia spectrum traits in the community. Schizophrenia Research 7:149–158PubMedCrossRefGoogle Scholar
  72. Torrey EF (1988) Stalking the schizovirus. Schizophrenia Bulletin 14:223–229PubMedCrossRefGoogle Scholar
  73. Van Os J, Fahy P, Bebbington P, Jones P, Wilkins S, Sham P, Russell A, Gilvarry K, Lewis S, Toone B, Murray R (1994) The influence of life events on the subsequent course of psychotic illness: a prospective follow-up of the Camberwell Collaborative Psychosis Study. Psychological Medicine 24:503–513PubMedCrossRefGoogle Scholar
  74. Van Os J, Hanssen M, Bijl RV, Ravelli A (2000) Strauss Revisited: a psychosis continuum in the general population? Schizophrenia Research 45:11–20PubMedCrossRefGoogle Scholar
  75. Van Os J, Hanssen M, Bijl RV, Vollebergh W (2001) Prevalence of psychotic disorder and community level of psychotic symptoms. Archives of General Psychiatry 58:663–668PubMedCrossRefGoogle Scholar
  76. Velakoulis D, Wood SJ, McGorry PD, Pantelis C (2000) Evidence for progression of brain structural abnormalities in schizophrenia: beyond the neurodevelopmental model. Australian and New Zealand Journal of Psychiatry 34 (Suppl):S113–S126PubMedGoogle Scholar
  77. Warner R (2001) The prevention of schizophrenia: what interventions are safe and effective? Schizophrenia Bulletin 27(4):551–562PubMedCrossRefGoogle Scholar
  78. Weinberger DR (1995) From neuropathology to neurodevelopment. Lancet 346:552–557PubMedCrossRefGoogle Scholar
  79. Wolkin A, Rusinek H (2002) A neuropathology of psychosis? Lancet published online, 10 DecemberGoogle Scholar
  80. Woods S, Zipursky R, Perkins D, Addington J, Marquez E, Breier A, McGlashan TH (2002) Olanzapine vs. placebo for prodromal symptoms. Acta Psychiatrica Scandinavica (Suppl) 106:43CrossRefGoogle Scholar
  81. Wyatt RJ, Henter I (2001) Rationale for the study of early intervention. Schizophrenia Research 51:69–76PubMedCrossRefGoogle Scholar
  82. Yolken RH, Karlsson H, Yee F, Johnston-Wilson NL, Torrey EF (2000) Endogenous retroviruses and schizophrenia. Brain Research Reviews 31:193–199PubMedCrossRefGoogle Scholar
  83. Yung AR, McGorry PD (1996) The initial prodrome in psychosis: descriptive and qualitative aspects. Australian and New Zealand Journal of Psychiatry 30:587–599PubMedCrossRefGoogle Scholar
  84. Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophrenia Bulletin 22:353–370PubMedCrossRefGoogle Scholar
  85. Yung AR, McGorry PD (1997) Is pre-psychotic intervention realistic in schizophrenia and related disorders? Australian and New Zealand Journal of Psychiatry 31:799–805PubMedCrossRefGoogle Scholar
  86. Yung AR, McGorry PD, McFarlane CA, Patton GC (1995) The PACE Clinic: development of a clinical service for young people at high risk of psychosis. Australasian Psychiatry 3:345–349CrossRefGoogle Scholar
  87. Yung AR, Phillips LJ, McGorry PD, Hallgren MA, McFarlane CA, Jackson HJ, Francey S, Patton GC (1998) Can we predict onset of first episode psychosis in a high risk group? International Clinical Psychopharmacology 13(Suppl 1):S23–S30CrossRefGoogle Scholar
  88. Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane C, Hallgren M, McGorry PD (2003) Psychosis prediction: 12 month follow-up of a high risk (`prodromal’) group. Schizophrenia Research 60:21–32PubMedCrossRefGoogle Scholar
  89. Yung AR, Yuen HP, McGorry PD, Phillips L, Kelly D, Dell-Olioi M, Francey S (2003) Mapping the onset of psychosis - the comprehensive assessment of at risk mental states (CAARMS). Australian and New Zealand Journal of Psychiatry (submitted)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • P. D. McGorry
    • 1
  • A. R. Yung
    • 1
  • L. J. Phillips
    • 1
  1. 1.ORYGEN Research Centre and University of Melbourne Department of PsychiatryORYGEN Youth HealthAustralien

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