Treating early psychosis: who, what, and when?

Abstract

Early intervention and prevention in schizophrenia is just over 10 years old. The assumption guiding this field is that intervention is likely to be most effective if it begins before psychosis sets in, ie, during the prodromal phase. Although a substantial number of prodromal treatment programs have been initiated around the world, three early programs have generated most of the intervention findings to date: Personal Assessment and Crisis Evaluation (PACE) in Australia, and the Prevention through Risk Identification, Management, and Education (PRIME) and Recognition and Prevention (RAP) programs in the USA. The data suggest that early intervention leads to a reduction in prodromal symptoms and clinical distress. However, prevention of psychosis remains an unresolved question. Other issues include defining who should be treated, with what, and when. In addition, treatment targets associated with functional disability, such as early prodromal negative symptoms and risk factors, continue to emerge. Newly identified targets, in turn, suggest the need for a variety of novel interventions and treatment strategies.

Figure 1.. Expanded four box model. CHR-: clinical high risk-negative; CHR+mod: clinical high risk-positive moderate; CHR+sev: clinical high risk-positive severe; SLP: schizophrenia-like psychosis.

Figure 2.. Preliminary outcome. Within each box are included those subjects who received that classification at study entry and who also have 1 year of follow-up. Arrows represent outcome as of a 1 June 2004 cutoff date. CHR-: clinical high risk-negative; CHR+mod: clinical high risk-positive moderate; CHR+sev: clinical high risk-positive severe; SLP: schizophrenia-like psychosis.