Implementing Early Intervention in Psychosis

Abstract

Schizophrenia is a devastating disease that affects 1% of the population worldwide and is associated with extreme disability. Individuals with the illness suffer profoundly, and the burden of the disease upon the individuals, their families, and society is compounded by the typical onset of the illness during early adulthood. While deterioration symptomatically and functionally often occurs early in the course of illness, treatment is often postponed. The average length of time from onset of psychotic symptoms to treatment is 1 year, and from onset of prodromal symptoms to treatment is 3 years.1,2 In Implementing Early Intervention in Psychosis, the authors outline the extent of the problem in recognizing and treating psychotic disorders early in their course and provide optimism that systems of care can be developed to render effective treatment. The authors have written a readable, thorough, and useful resource for clinicians working in community settings. Building on the work of a number of researchers throughout the 1990s, the authors assert that early intervention and treatment can lessen the deterioration and relapse that are prominent during the first few years in the course of psychosis. Tailored treatment can preserve social supports and functioning and decrease repeated hospitalizations and incarcerations, the development of substance abuse disorders, and morbidity and mortality associated with psychosis. Edwards and McGorry divide the book into 2 sections: the first explores the extent of the problem and the second gives a step-by-step guide to developing services in a community. The first section will appeal to any clinician working in the community as it takes the clinician through the process of engagement, assessment, and treatment with a young adult experiencing the onset of psychosis. The authors clearly recognize that most individuals with early symptoms of psychosis will present to their primary care clinician, a clinician who has limited time, perhaps with little experience and training in this area, and with little or no access to specialized systems of care. Clinically oriented and sensitive to the limited resources faced by most community-based primary care clinicians and psychiatrists, these few chapters in the first section serve as an excellent primer for providers and teachers. Keeping this book on hand will benefit any clinician helping patients and their families understand the onset of psychotic disorders. The second half of the book may be of less use to professionals whose work is primarily clinical. However, those involved in planning and developing systems of care will find useful the discussion of the steps involved in establishing services for individuals with new-onset psychosis. The authors draw from their own experiences and refer to programs throughout the world in discussing options that range from community needs assessment, to developing a Web site, to the pros and cons of developing specialized services separate from existing services versus integrating new programs within existing services. The diversity of programs and communities discussed inspires the reader to optimism that any community can develop a program to recognize and treat psychosis in its early stages. This book is a brief, accessible resource guide that will serve as an excellent introduction for community-based clinicians and provide the interested reader with a more in-depth approach to the problem of psychosis. Working with the International Early Psychosis Association, the authors have furthered the knowledge base on treating psychotic disorders and provided guidance and hope for providers working in the field.