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The Recognition and Management of Early Psychosis: A Preventive Approach.

Year: 2003
Type: article
Abstract: It is fitting that The Recognition and Management of Early Psychosis, the first book to focus on the topic of early psychosis, is edited by Dr. Patrick McGorry along with Henry Jackson, one of his long time collaborators. More than any other single person, Dr. McGorry has provided leadership, inspiration and energy over the past decade for what can be called ‘the early psychosis movement,’ an effort with no less lofty a goal than to change fundamentally the way psychiatry conceptualizes psychotic disorders. Central to this new paradigm, which Dr. McGorry clearly articulates in the introductory chapter, entitled ‘A stitch in time...’, is a rejection of the pessimism which has been endemic among clinicians regarding the prognosis for people with psychotic disorders, including schizophrenia. In its place, McGorry offers optimism based on research as well clinical experience demonstrating that psychotic disorders are highly treatable. Perhaps more importantly, McGorry goes beyond the idea of providing access to best practice clinical services for patients once a psychotic disorder emerges, ie secondary prevention. He cogently argues for ‘indicated prevention,’ meaning treatment prior to the appearance of the full clinical syndrome. Of great interest is the summary, by Dr. Alison Yung, of recent results from Australia demonstrating criteria that identify a pre-psychotic patient group in which 40–50% of the patients convert to full-fledged psychotic disorder within 12 months of detection. The development of the Personal Assistance and Crisis Evaluation clinic (PACE) provides practical information about organizing services for this patient population. As might be expected, much of the material in the book is drawn from the work of Dr. McGorry and his colleagues in Melbourne, Australia. The Early Psychosis Intervention and Prevention Centre (EPPIC), which they have developed over the past decade, is perhaps the most comprehensive early psychosis program in the world. EPPIC provides service for the entire state of Victoria, and specifically within an 800,000-population catchment area. About 250 persons with recent onset psychosis enter the program each year. Patients remain in the program for 18 months. Key to the EPPIC approach is the early identification of psychosis. Dr. Yung provides a concise and readable summary of research findings regarding the onset of psychosis and the organization of the EPPIC assessment services, which includes a rapid response team. The chapter on initial treatment of psychosis, by Drs. Kukarni and Power clearly presents the ‘myths’ about psychosis which have guided treatment in the past (for example, schizophrenia is a chronic, deteriorating illness) along with a useful discussion of the common fears among patients regarding drug therapy. Additional chapters on psychological interventions, case management, substance abuse, family interventions and day programs provide an in depth review of the components of the EPPIC program and how they relate to the early intervention paradigm. The sixteen chapters of the book read like a manual for those interested in establishing an early psychosis service. Clinical case vignettes are used frequently to illustrate the practicalities of providing service at the earliest possible point in the course of psychosis. The final chapter, sub-titled ‘Early Intervention In The Real World,’ directly addresses the process of creating an early psychosis service and the obstacles that may be encountered. In this, and other chapters, the current state of research evidence supporting an early intervention paradigm is presented in a forthright manner. For example, it is clearly acknowledged that the question of whether a reduction in the duration of untreated psychosis will, in and of itself, result in an improvement in clinical outcomes, remains to be answered. It is noted that studies are in progress in Scandinavia aimed at answering this and related questions. McGorry argues that it is important to proceed in developing services while carrying out evaluative research. The authors note that as new early psychosis programs emerge throughout the world they will naturally develop in different ways depending upon the local context. If there is a drawback to this book it would be that so much of the content is drawn from the EPPIC experience that the reader may feel overwhelmed by the thought of re-creating the extensive programming that makes up EPPIC or confuse the specifics of the EPPIC program for the essence of the early psychosis paradigm. However, that possibility is a small price to pay for the richness of the presentation in this book. There is no doubt that this text marks a milestone in the growing efforts to take a more optimistic and assertive view of psychotic disorders and their treatment, a change which can only benefit the next generation of young people with psychosis and those who care for them.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W181936783
FWCI: 0.178
Cites:
Cited by: 9
Related to: 10