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I've covered many aspects of early intervention and prevention in previous columns. It is in my opinion the future of schizophrenia. The low dosing for first episodes is particularly appealing. It may be quite some time before we see that future take place unfortunately, for a variety of reasons. First psychotic episode programs are almost always research projects, with the notable exception of Australia's EPPIC program. As such, even though results can be very self evident, it will take five, ten, fifteen years before their success or failure is actually documented in the academic journals. To determine the effectiveness of focusing resources on the first psychotic episode you have to follow individuals for five, ten, fifteen years after the intervention. Early intervention may be very successful when the individual is 18 years old. There is as yet no body of research indicating the individual will maintain that level of recovery for the rest of their life. Some psychiatrists believe there is a natural deteriorating course to schizophrenia. Any individual will become increasingly disabled over the course of their life with or without early intervention. Why invest money in an early intervention program, when it might not make any difference in the long run.
Many regions have very limited resources. Given the legacy of disabled people in their community, many mental health administrators see a much higher priority for an ACT team over an early intervention program. An ACT program (Assertive Community Outreach Team) is an intensive form of case management that focuses on people having a lot of trouble living in the community, usually because they are either noncompliant, very disabled or both. The argument that it is more important to prevent people from ever needing an ACT team doesn't hold water if you don't think that is possible. There are other more generic problems to early intervention. Schizophrenia is stigmatized to some extent even among psychiatrists. Some psychiatrists won't take patients with schizophrenia. Many psychiatrists won't live and practice in smaller communities. In Ontario the government hasn't allowed enough physicains to be trained in medical school, and psychiatry is not a first choice for medical students. The end result is that there are never enough psychiatrists vis-a-vis people with schizophrenia, let alone for a focused early intervention program. To be effective it would appear early intervention really does have to be quite early. In London Ontario, Dr. Ashok Malla has told me the first six months of psychosis are critical. If he can treat an individual in the first six months of the first psychotic episode, he gets a complete recovery 90% of the time. The point of intervention, even in London with a well established, university financed first episode program is two years. First Episode patients experience psychotic symptoms for an average of two years before they are treated, which is too late.
The copyright of the article Early Intervention and Prevention in Schizophrenia is owned by . Permission to republish Early Intervention and Prevention in print or online must be granted by the author in writing.
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