Is Early Intervention for Psychosis Feasible and Effective?

Abstract

Synopsis Services that provide comprehensive, early intervention (EI) have shown promise in improving long-term outcomes in schizophrenia. This paper reviews the rationale and salient concepts relevant to understanding the growing EI literature. A selective review of studies evaluating the effectiveness of integrated EI is followed by a discussion of feasibility, especially in the U.S. context. Finally, the authors present a framework that seeks to integrate activities traditionally categorized and separated as discovery and implementation. This framework is offered as one way to advance both goals.

Much ado about much: Stress, dynamic biomarkers and HPA axis dysregulation along the trajectory to psychosis

“…Conclusions: We consider potential explanations for the seemingly contradictory elevation and blunting of HPA biomarkers in the early course of psychosis. Finally, we propose and explore implications of a conceptual model of tonic HPA hyperactivation and phasic HPA blunting that integrates and reconciles these data.The first few years before and after the onset of psychosis are significant in terms of both neurobiological and socio-environmental changes (Tandon et al, 2008;Addington and Heinssen, 2012;Fusar-Poli et al, 2013) and in their association with long-term outcomes (Birchwood et al, 1998;Malla et al, 2005;Srihari et al, 2012). The accumulation of such evidence strongly suggests that this 'critical period' is relevant for understanding and potentially intervening in the factors that contribute to psychosis.…”

Cognitive intervention in early psychosis — preserving abilities versus remediating deficits

“…Early intervention strategies have had positive long-term effects on symptomatic and functional domains, and are economically feasible, when compared to standard models of care [66,67]. The most commonly used cognitive intervention strategy in schizophrenia is cognitive remediation (CR), which is defined as 'a behavioural training based intervention that aims to improve cognitive processes (attention, memory, executive function, social cognition or metacognition) with the goal of durability and generalization' 68 , p. 1].…”

First-Episode Services for Psychotic Disorders in the U.S. Public Sector: A Pragmatic Randomized Controlled Trial

“…Several pharmacologic and psychological interventions have improved outcomes(4) during this critical ‘window of opportunity’ for ameliorating long term disability(5). Of particular promise are comprehensive first-episode services (FES) with teams that integrate and adapt the delivery of empirically based treatments to younger patients and their families(6). …”