Academic journal article Indian Journal of Psychiatry

Early Intervention in Schizophrenia

Academic journal article Indian Journal of Psychiatry

Early Intervention in Schizophrenia

Article excerpt

Byline: Parmanand. Kulhara, Anindya. Banerjee, Alakananda. Dutt

Early intervention (EI) programs in schizophrenia and other psychoses are aimed at early detection (ED) of the disease; prevent conversion to manifested psychosis and phase-specific treatment to reduce development of chronic disabilities. EI strategies include targeting people at "high risk" for developing schizophrenia, intervening in prodromal phase of schizophrenia, and reducing the "duration of untreated psychosis" (DUP). Services are delivered by a specialized team and are usually resource intensive. Several strategies like treatment with antipsychotics, family interventions, and cognitive behavior therapy have been tried with modest success in prodromal patients. Significant ethical reservations exist regarding exposing prodromal patients to the stigma of labeling as "high risk for schizophrenia" and side effects of psychotropics in the absence of clear evidence of efficacy in favor of ED, intervention by specialist teams, and phase-specific interventions in prodrome of psychosis. More research is warranted to demonstrate the risk-benefit and cost-benefit of such interventions before these can be routinely recommended.

Introduction

Schizophrenia and other functional psychoses cause enormous suffering for individuals and their families. Despite new medications and community care, about one-third of people with schizophrenia have a poor long-term outcome. People with schizophrenia show a one-year relapse rate of 15–35%, rising to 80% within 5 years.[sup] [1],[2] Achievement of full remission becomes less likely after each relapse and about 10% of sufferers eventually commit suicide. Even in developed nations like the United Kingdom, treatment is often delayed and it may take up to 2 years for families to seek help from first signs of psychosis.[sup] [3] Additionally, schizophrenia is a leading cause of health care expenditure, accounting for 2.5% (US $17.3 billion) of total health expenditure of USA, and in-patients accounted for 51% of total public sector expenditure on schizophrenia care.[sup] [4]

There are two approaches toward treatment of schizophrenia. In the orthodox approach, therapeutic resources are concentrated on people with established diagnosis. By the time help is sought, patients usually have severe and chronic disabilities. The new approach focuses on "early intervention" (EI) which involves greater investment of resources in the early stages of the disorder to reduce the number of people developing chronic disabilities. This notion is supported by the association between various outcome parameters and the duration of untreated psychosis (DUP).

Scope of Article

In this article, we discuss the components of EI---comprising early recognition in "high-risk" populations or in people with schizophrenia 'prodrome' and phase-specific treatment to reduce the DUP. We also review the efficacy and effectiveness of EI programs in schizophrenia.

Early Recognition

A key component of all EI is early recognition of the problem - ideally even before the emergence of clear-cut psychotic symptoms. There are two approaches to identify subjects who may manifest psychotic symptoms in later life: to target subjects who are at "high risk" to develop psychosis and those who display features of "prodrome" of schizophrenia.

Early recognition: High-risk approach

Studies to identify high-risk groups: These can be grouped under three categories:

Genetic/family studies Birth cohort studies High-risk projects

Genetic/family studies: Genetic loading is known to be an important risk factor in schizophrenia and schizophrenia spectrum disorders. The lifetime risk of developing schizophrenia is about 10 times higher in first degree relatives of schizophrenia patients compared to the general population.[sup] [5]

Birth cohort studies: Data from birth cohort studies indicate that low intelligence quotient at age 18, delayed motor milestones, motor co-ordination deficits, social and attention dysfunction in childhood, impaired social functioning, and behavioral abnormalities may predispose to higher risk of developing schizophrenia in later life. …

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