Improving outcome in schizophrenia: the case for early intervention

The long-term course of schizophrenia, one of the world’s most seriouspublic health problems,1 is generally regarded as one of chronicity anddisability.2–8 Despite the availability of treatment, more than 50 % of pa-tients continue to exhibit moderate levels of “positive symptoms ” such as delu-sions, hallucinations, and disorganized thinking and behaviour, and “negative symptoms ” such as poverty of thought, volition and affect, and social and inter-personal withdrawal, and require long-term support and periodic admission to hospital.9,10 It is therefore important to find ways to improve long-term outcome. We reviewed the literature to examine the impact of strategies to improve long-term outcome, the factors that influence outcome and the evidence supporting early intervention as a means to improve outcome. The difficulties inherent in defining outcome are well documented. For this review, we used the description of Hegarty and colleagues,11 who stated that “pa-tients considered improved in follow-up have been described as recovered, in re-mission, without symptoms, minimally or mildly symptomatic, improved without significant deficit, socially recovered, working or living independently.” Impact of treatment on outcom