title: Early intervention in psychosis: a new evidence based paradigm.
abstract: OBJECTIVE
  Even in countries whose mental health services are comparatively well resourced, the care offered to those in the early stages of psychotic illnesses is not what it could be. Patients often have to progress to chronicity before receiving adequate interventions, by which stage there has been great potential for harm, not only through the psychosis, but also to the quality of life of the individual who has often missed or not completed adequately, several important developmental tasks. Further, evidence indicates that delay in treatment is positively associated with poorer outcome. This paper puts the case for early intervention in psychosis.
  
  
  METHODS
  Based on the experience of the Early Psychosis Prevention and Intervention Centre in Melbourne, the paper reviews the evidence for and the criticisms of, early intervention. Using the concept of indicated prevention, it suggests ways in which clinicians can improve the interventions available to those experiencing the onset of psychosis and suggests that pre-psychotic intervention may be possible.
  
  
  RESULTS
  Evidence discussed in this paper indicates that the development of mental illness is a major health issue in young people; that there is a positive correlation between duration of untreated psychosis and outcome; that it is possible to identify a proportion of those at high risk of developing mental illness; that through intervention it may be possible to reduce the transition rate to illness.
  
  
  CONCLUSIONS
  Primary prevention is beyond the capacity of our present knowledge. Indicated prevention in the form of early intervention and optimal, sustained treatment is a paradigm for which there is increasing supportive evidence. It is a paradigm which is appealing to clinicians, patients, families and which has the potential to reduce the secondary impact of serious mental illness such as suicide, stigma, isolation and reduction in social status.
authors.affiliation: Early Psychosis Prevention & Intervention Centre, Victoria, Australia. mcgorry@ariel.unimelb.edu.au
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.forename: Eoin J
authors.initials: EJ
authors.lastname: Killackey
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D011618:Psychotic Disorders / Q000517:prevention & control / Q000628:therapy*; D013997:Time Factors