Early intervention in schizophrenia: a critique. Epidemiol Psichiatr Soc

Two very different forms of early intervention in schizophrenia being proposed currently – pre-illness intervention (intervention with at-risk individuals) and intervention after the onset of psychosis (early detection and intervention). The risks of harm, the prospects of success and the supportive evidence for each approach are very different (Larsen et al., 2001; McGlashan et al., 2001). We may begin by examining the potential risks and benefits of early treatment for those who demonstrate the full syndrome of schizophrenia – a form of tertiary prevention in Caplan’s (1964) terminology. Crow et al. (1986) found that first-admission patients with schizophrenia whose onset of psychotic symptoms preceded the start of antipsychotic medication by more than a year were more likely to relapse at follow-up than those whose symptoms went untreated for less than a year; these workers suggested that failure to initiate early treatment may heighten the risk of relapse. Further theoretical support for early intervention rests in the data which indicate that the duration of untreated psychosis (DUP) is associated with psychosocial decline (Jones et al., 1993), prolonged morbidity (Wyatt et al., 1997), increased treatment costs (Moscarelli et al., 1991), worse course and outcome (Helgason, 1990; Haas et al., 1998), and increased duration of the acute episode (Loebel e