A Canadian programme for early intervention in non-affective psychotic disorders.
OBJECTIVE
To provide a brief overview of the development of clinical services and research for early intervention in psychotic disorders in Canada; to describe components of a comprehensive clinical/research programme for nonaffective psychotic disorders; and to present a summary of results of clinical and social outcomes achieved.


METHODS
This is a descriptive paper providing some details of how clinical services are being developed in Canada and concentrating on one particular early intervention programme, Prevention and Early intervention Programme for Psychoses (PEPP) London, Ontario, which is using a historical control design to evaluate the impact of an assertive approach to community case detection. Components of a phase-specific treatment programme and early case detection are described followed by results based on clinical and psychosocial data collected according to a defined protocol.


RESULTS
One year outcome for patients treated in PEPP shows use of low dose, pre-dominantly novel antipsychotics and high (81.5%) retention and remission (75%) rates. Highly significant improvements were also reported for self-rated quality of life and cognition. Duration of untreated psychosis (DUP) and premorbid adjustment were associated with improvement in positive and negative symptoms, respectively. Systemic changes to improve access to the service resulted in substantial increases in number of cases treated and a> 50% decline in DUP.


CONCLUSIONS
Phase-specific treatment approach and case identification strategies to reduce delay in treatment are likely to substantially improve outcome in nonaffective psychotic disorders compared with what has been reported with traditional approaches.
Malla
Ashok
A
Division of Clinical Research, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Boul, Verdun, Québec, Canada, H4H 1R3. ashok.malla@douglas.mcgill.ca
Norman
Ross
R
McLean
Terry
T
Scholten
Derek
D
Townsend
Laurel
L
D002170:Canada; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000628:therapy*; D013997:Time Factors