The feasibility and effectiveness of early intervention in psychotic disorders

Abstract

In an attempt to provide optimum treatment for young people with emergent psychosis, we have developed the Early Psychosis Prevention and Intervention Centre (EPPIC), which is designed to identify young patients in the early stages of first-episode psychosis and provide them with a comprehensive, sustained community-based service intended to minimize primary and secondary morbidity. Key elements of EPPIC are the mobile Early Psychosis Assessment Team, minimal inpatient treatment, continuity of care, a day program for recovering patients, specialist family work, and cognitively oriented psychotherapy for early psychosis. Preliminary evaluation of this model against our previous intensive inpatient program, comparing 51 EPPIC patients treated in March-October 1993 with 51 pre-EPPIC historical controls (1989-1992) matched for key variables, indicates that the EPPIC model is associated with shorter durations of untreated psychosis, reduced inpatient treatment, reduced neuroleptic use without deterioration in Brief Psychiatric Rating Scale scores, improvements in negative symptoms and better psychosocial functioning. The EPPIC program is cheaper and more cost-effective than the pre-EPPIC system, even within a 12-month follow-up period. Early intervention with an approach tailored to the specific needs of young first-episode patients is feasible and effective. Future research should focus on optimizing pharmacotherapy and integrating this with specialist psychological treatments, early identification of treatment-resistant patients and, ultimately, prepsychotic identification and intervention.