Early intervention in psychosis

TLDR

The early phase of psychosis, including untreated periods, is a critical window where long‑term outcomes are predictable and biological, psychological, and psychosocial influences develop with maximum plasticity. The study outlines a prototype intervention tailored to this critical early phase of psychosis. The authors review first‑episode prospective studies on outcome predictors and patients’ appraisals, and propose a prototype intervention for the critical period. The data confirm a plateau effect with rapid deterioration in the first 2–3 years, highlight the emergence of critical psychosocial influences, challenge the notion that first‑episode psychosis is benign, and emphasize the early phase as a key opportunity for secondary prevention.

Abstract

Background We consider the evidence for the proposition that the early phase of psychosis (including the period of untreated psychosis) is a critical period' in which (a) long-term outcome is predictable, and (b) biological, psychological and psychosocial influences are developing and show maximum plasticity. Method First-episode prospective studies, predictors of outcome and the genesis of patients' key appraisals of their psychosis are reviewed. Results The data support the notion of the ‘plateau effect’, first coined by Tom McGlashan, which suggested that where deterioration occurs, it does so aggressively in the first 2-3 years; and that critical psychosocial influences, including family and psychological reactions to psychosis and psychiatric services, develop during this period. Conclusions The early phase of psychosis presents important opportunities for secondary prevention. We outline a prototype of intervention appropriate to the critical period. The data challenge the widely held assumption that first-episode psychosis is a benign illness posing little risk.