Early detection and treatment delay: implications for outcome in early psychosis

Current Opinion in Psychiatry

Volumn 13, Issue 1, 2000, Pages 37-43

  McGorry, Patrick D ^a   Krstev, Helen ^a   Harrigan, Susy ^a  

^a UNIVERSITY OF MELBOURNE   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

NEUROLEPTIC AGENT;

COST EFFECTIVENESS ANALYSIS; DISEASE DURATION; HUMAN; PSYCHOSIS; PSYCHOSOCIAL DISORDER; RELAPSE; REVIEW; SCHIZOPHRENIA; TREATMENT OUTCOME;

EID: 0033957154     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200001000-00007     Document Type: Review

References (78)

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29. 29 Carbone S, Harrigan S, McGorry P, Curry C, Elkins K. Duration of untreated psychosis and 12-month outcome in first-episode psychosis: the impact of treatment approach. Acta Psychiatr Scand 1999; 100:96-104. A sample of 250 FEP cases was studied to compare the 12-month outcomes of individuals from two different models of service delivery-a specialized early intervention centre and its predecessor-and revealed that only clients with a mid-range DUP (1-6 months) experienced better outcomes. This study highlights the potential limited window of opportunity in which to influence short-term outcome.
30. 30 Padmavathi R, Rajkumar S, Srinivasan T. Schizophrenic patients who were never treated: a study in an Indian urban community. Psychol Med 1998; 28:1113-1117. This study represents significant contribution to our understanding of the treated incidence of psychotic disorders, because it is one the few population-based studies available. Almost one-third of people who experienced an episode of psychosis had never been treated for their psychosism, and it was identified that having a larger extended family was associated with nontreatment. It remains unclear, however, to what extent these findings are culture-specific.
31. 31 McGlashan T. Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biol Psychiatry 1999; 46:899-907. This is a comprehensive and current review of the relationship of DUP to course and outcome, with some new data included.
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35. 35 Robinson D, Woerner M, Alvir J, Bilder R, Goldman R, Geisler S, et al. Predictors of relapse following response from a first-episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56:241-247. This paper examined relapse rates after response in a sample of 118 people with a first-episode of schizophrenia spectrum disorders, and found a cumulative first relapse rate of 81.9% within the first 5 years after recovery. This risk was increased almost 5 times when drug therapy was discontinued. The authors found that duration of untreated psychosis was not related to time to relapse, however.
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50. 50 McGorry P, Edwards J, Mihalopoulos C, Harrigan S, Jackson H. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22:305-326.
51. 51 Lincoln C, Harrigan S, McGorry P. Understanding the topogaphy of the early psychosis pathways. Br J Psychiatry 1998; 172(Suppl 33):21-25. This study examined the pathways to care for early psychosis and reported that at as many as 50% of young people experienced psychotic symptoms before seeking professional help, and that the general practitioner played a potentially pivotal role in identification. This is an important paper that provides a framework for targeted intervention strategies.
52. 52 Herman D, Susser E, Jandorf L, Lavelle J, Bromet E. Homelessness among individuals with psychotic disorders hospitalized for the first time: findings from the Suffolk County Mental Health Project. Am J Psychiatry 1998; 155:109-113. This crucial study that highlights alarming rates of homelessness among FEP patients in the US setting. Of those studied, 15% had experienced homelessness before or within 2 years of their first hospitalization, irrespective of diagnosis. Furthermore, a greater severity of negative symptoms was associated with this risk of homelessness.
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58. 58 McGorry P, Edwards J (editors). Early psychosis training pack. Cheshire, UK: Gardiner-Caldwell Communications Ltd; 1997.
59. 59 McGorry PE. Preventive strategies in early psychosis: verging on reality. Br J Psychiatry 1998; 172(Suppl 33):1-136. This is a supplement on early psychosis collecting together a series of papers presented at an international conference held in Melbourne, Australia in June 1996. It is a valuable resource of clinical and research material.
60. 60 Aitchinson K, Meehan K, Murrary R. First episode psychosis. London: Martin Dunitz Ltd; 1999. This is a practical handbook that collates the existing literature in a user-friendly manner for the practicing clinician. The format is excellent.
61. 61 McGorry P, Jackson H (editors). The recognition and management of early psychosis: a preventive approach. Cambridge, UK: Cambridge University Press; 1999. This is a comprehensive handbook of clinical and research material based on the experience of the Early Psychosis Prevention and Intervention Centre group, with some international contributions.
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66. 66 Power P, Elkins K, Adlard S, Curry C, McGorry P, Harrigan S. Analysis of the initial treatment phase in first-episode psychosis. Br J Psychiatry 1998; 172(Suppl 33):71-76. Conducted a 'real world' audit of the initial treatment phase in early psychosis, in a sample of 231 consecutive clients admitted to the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. It is a crucial paper as it is one of few 'real world' research studies using a highly representative sample of first-episode clients. It provides support for specialized early intervention strategies using low-doses of medication and intensive psychosocial treatment, achieving favourable results. It is one of the few studies to depict the evolution of its clinical practice.
67. 67 Fitzgerald P, Kulkarni J. Home-oriented management programme for people with early psychosis. Br J Psychiatry 1998; 172(Suppl 33):39-44. This paper outlined an innovative model for the home-based treatment of clients with FEP.
68. 68 Albiston D, Francey S, Harrigan S. Group programmes for recovery from early psychosis. Br J Psychiatry 1998; 172(Suppl 33):117-121. This naturalistic study illustrates the important role that group programmes make in arresting psychosocial decline in early psychosis.
69. 69 Sanger T, Lieberman J, Tohen M, Grundy S, Beasley C, Tollefson G. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156:79-87.
70. 70 Remington G, Kapur S, Zipursky R. Pharmacotherapy of first-episode schizophrenia. Br J Psychiatry 1998; 172(Suppl 33):66-70.
71. 2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia. Am J Psychiatry 1999; 156:286-293. This paper that provides neurobiological support for low-dose strategies, especially with the newer antipsychotic medications, but also with typical neuroleptics.
72. 72 Haddock G, Morrison A, Hopkins R, Lewis S, Tarrier N. Individual cognitive-behavioural interventions in early psychosis. Br J Psychiatry 1998; 172(Suppl 33):101-106.
73. 73 Jackson H, McGorry P, Edwards J, Hulbert C, Henry L, Francey S, et al. Cognitively-oriented psychotherapy for early psychosis (COPE). Br J Psychiatry 1998; 172(Suppl 33):93-100. This is a pilot test of psychotherapy for people with FEP that aimed to facilitate the adjustment of the person and reduce secondary morbidity. Some promising findings for the use of psychological therapies in early psychosis with replication studies in progress.
74. 74 Edwards J, Maude D, McGorry P, Cocks J, Burnett P, Davern M, et al. Treatment of enduring positive symptoms in first-episode psychosis: a randomised controlled trial of CBT and clozapine. Abstracts of the VIIth International Congress on Schizophrenia Research. Schizophr Res 1999; 36:278.
75. 75 McGorry P, Jackson H, Edwards J, Hulbert C, Phillips L, Henry L, et al. Preventively-oriented psychological interventions in early psychosis. In Psychological treatments for schizophrenia. Oxford, England: Institute of Psychiatriy, The University of Manchester; 1999.
76. 76 Tarrier N, Lewis S. SoCRATES: a CBT trial for the early stages of psychosis. In Psychological treatments for schizophrenia. Oxford, England: Institute of Psychiatry, The University of Manchester; 1999.
77. 77 McGorry P, Edwards J. The feasibility and effectiveness of early intervention in psychotic disorders: the Australian experience. Int J Clin Psychopharmacol 1998; 13(Suppl 1):47-52.
78. 78 Mihalopoulos C, McGorry P, Carter R. Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome. Acta Psychiatr Scand 1999; 100:47-55. This is a cost-effectiveness analysis of a specialized service with a greater emphasis on community treatment compared with its immediate precursor service. Although only direct costs were calculated, the specialized service proved to be more cost-effective, since costs were somewhat reduced and treatment outcomes were more superior.