Abstract
One of the major advances over the past 20 years in psychiatry is the capacity not only to identify people at incipient risk for psychosis and other disabling mental disorders, but also to improve their levels of distress and functioning and reduce their risk of progression to sustained psychotic disorder, at least while treatment is being provided and for at least 1-2 years from baseline. These statements are supported by level 1 Cochrane evidence and one would expect this progress to be understood and valued by a field in need of positive findings pointing to better outcomes. It is therefore puzzling why recent meta-analyses appear to have focused on second order issues and in doing so have distracted from the key message of this research literature and fuelled the traditional skepticism and pessimism with which our discipline is so replete.
Highlights
Specialty section: This article was submitted to Schizophrenia, a section of the journal Frontiers in Psychiatry
The authors conclude from their analysis that there is no evidence that any specific intervention is more effective than any other trialed intervention in preventing onset of psychosis and that “individuals meeting CHR-P criteria may be informed that, at present, there is no evidence for specific treatments being more effective than any others, and current options should be carefully weighted on a personal basis depending on an individual’s needs” (p.206)
While it may well be true that the field has not yet identified a single specific intervention that is more effective than others, the trials do show that most patients improve in response to treatment provided in specialist research clinics and transitions are at least delayed
Summary
Specialty section: This article was submitted to Schizophrenia, a section of the journal Frontiers in Psychiatry. One of the major advances over the past 20 years in psychiatry is the capacity to identify people at incipient risk for psychosis and other disabling mental disorders, and to improve their levels of distress and functioning and reduce their risk of progression to sustained psychotic disorder, at least while treatment is being provided and for at least 1–2 years from baseline.
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