9.1 Early-Psychosis Detection and Intervention

Early-psychosis detection and intervention programmes generally aim to reduce the duration of untreated psychosis (DUP). The DUP is the period supposedly preceding first treatment for schizophrenia during which symptoms and signs of an impending psychological or social crisis are present. Medical psychiatrists argue that the DUP for most people who develop psychosis is much longer than it should be, often lasting for years.[5]

It has been claimed that ‘the cost of treatment for patients with a DUP greater than 6 months is twice the cost of those with a DUP less than 6 months’. Some argue that brain damage is occurring during the DUP and that the longer it continues the less chance a person has of ultimate recovery: ‘most of the neurobiological damage is already accomplished by the time it is possible to make a valid DSM-IV diagnosis’ and ‘applying existing schizophrenia treatment as soon as possible in the course of the disorder may slow or stop deterioration’.[6] But apart from the equivocal evidence of initial pilot studies,[7] no substantial findings support these contentions.

Nevertheless, despite the weak theoretical base, it has been claimed that when a programme of early detection and intervention was put into place at Buckingham in the United Kingdom in the mid-1980s, the incidence of schizophrenia in the community was measurably reduced.[8] These findings have not been replicated. This is not surprising, as the Buckingham Project’s ‘diagnostic thresholds for functional psychotic disorders’ appear to have been uniquely flexible, and a considerable number of cases ‘with symptom patterns suggesting an early phase of a florid schizophrenic episode’[9] were not counted. This diagnostic flexibility is the most likely explanation for the supposedly ‘successful’ outcome of the Project.

Yet the claimed success of the Buckingham Project has been the basis for a growing body of literature and the initiation of early-psychosis projects in other parts of the world. The promoters of these programmes now face the task of reaching consensus on three points: an inventory of easily recognisable pre-psychotic symptoms; the design of a community-based catchment system that funnels at-risk people into a clinical setting; and an appropriate pre-psychosis treatment programme.

[5] Tor K. Larsen et al., ‘First-Episode Schizophrenia: 1. Early Course Parameters’, pp. 241–56.

[6] Thomas H. McGlashan and Jan Olav Johannessen, ‘Early Detection and Intervention With Schizophrenia: Rationale’, pp. 209, 201, 212.

[7] Jay W. Pettegrew et al., ‘Alterations in Brain High-Energy Phosphate and Membrane Phospholid Metabolism in First-Episode, Drug-Naive Schizophrenics: A Pilot Study of the Dorsal Prefrontal Cortex by In Vivo Phosphorus 31 Nuclear Magnetic Resonance Spectroscopy’, pp. 563-68.

[8] Ian R. H. Falloon et al., ‘Early Detection and Intervention for Initial Episodes of Schizophrenia’, pp. 271–82.

[9] Ibid., p. 279.