First-episode psychosis, early intervention, and outcome: what have we learned?
OBJECTIVE
There has been increased interest in the potential of early intervention to positively influence outcome in first-episode psychosis (FEP) and, consequently, to influence mental health policy and practice. This study's objective was to examine the concept of early intervention and the evidence that currently exists to support such a shift in the delivery of care.


METHODS
We examined the evidence for phase-specific treatment of FEP, looking for interventions that attempt to arrest the transition from a putative prodromal state to full psychosis, as well as for interventions that attempt to reduce delay in treatment.


RESULTS
Some evidence supports specialized FEP interventions for short-term outcome in terms of symptom reduction, relapse rates, and greater adherence to and retention in treatment. As well, there is modest support for benefits to aspects of social and community functioning and satisfaction with life. Limited evidence supports a positive effect of community-wide case detection in terms of reduced delays in treatment and pharmacologic and psychological interventions in the prodromal phase.


CONCLUSIONS
The field of early intervention in psychosis is young, with encouraging preliminary results, especially for improving outcome in established FEP. It requires further study, especially of longer-term outcome. Further studies need to examine the effects of a specialized approach on longer-term outcome and to explore cost-effective methods to reduce delays in treatment and provide interventions in the prodromal phase.
Department of Psychiatry, McGill University, Montreal, Quebec. ashok.malla@douglas.mcgill.ca
Ashok K
AK
Malla
Ross M G
RM
Norman
Ridha
R
Joober
D015928:Cognitive Behavioral Therapy; D004569:Electroencephalography; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012050:Rehabilitation, Vocational; D012074:Remission Induction; D016896:Treatment Outcome