Early Recognition and Intervention: The Key to Success in the Treatment of Schizophrenia?
Jan Olav Johannessen
Schizophrenia is possibly the single most costly disorder in psychiatric or somatic medicine, despite a relatively low yearly incidence of about 10/100 000/ year. In many cases it is a life-long disabling disorder. Available treatments, including medication, psychotherapy and family treatments are largely palliative and seem to be of only limited value. This may be due to an apparent delay in providing treatment early in the course of the illness. Schizophrenia can be regarded as a disorder that develops in stages: premorbid, prodromal and psychotic. Research over the last few years indicates that early treatment for schizophrenia may improve the course of the disorder. Projects aimed at intervening in the prodromal phase of the disorder have shown that it may be possible to reduce the incidence in a catchment area (Buckingham, UK), or prevent the conversion of prodromal cases into fulminate psychosis (Melbourne, Australia). In Norway, the Early Treatment and Intervention in Psychosis (TIPS) project demonstrated that it was possible to reduce the duration of untreated psychosis within a catchment area from a mean of 114 weeks to 26 weeks, and thus dramatically reduce the total period of psychosis. There are also indications that earlier detection results in patients who present with less severe psychopathology. Earlier detection is possible through information campaigns which enhance the public's knowledge about serious psychiatric disorders, and aim to reduce the stigma associated with this disorder and change help-seeking behavior. Earlier intervention requires easy access to psychiatric health services, and early, comprehensive treatment programs. Early detection and intervention can be managed successfully ensuring patients are provided with treatment at an earlier point in the development of the illness. Such programs are relatively inexpensive, since it is a question of organizing the health services in a way that meets the population's needs.
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