Skip to main content

Critical period and duration of untreated psychosis

Author/s
Yuliya Zaytseva
Citation
Issue 1 Summer 2011
CEPiP.2011.1.41-45
Abstract

The paradigm of early intervention in psychosis has been highly promoted due to the growing body of evidence from prospective studies and randomised controlled trials that the specific interventions in early phase of psychosis induce better clinical and functional outcomes. Thus, early intervention services have become an important area of the Community Mental Health development in recent years. The large number of clinical and research programmes focusing on early psychosis have now been established. Early intervention can be conceptualized as a series of preventive strategies, comprising three components, interconnected with each other: 1) early detection of emerging psychosis; 2) reducing delay in the initiation of treatment; 3) providing continuous intervention during the early phase of psychosis or so called critical period. The potential benefits of early intervention also include: reduced morbidity, more rapid recovery, better prognosis, preservation of social skills, family and social supports and decreased need for hospitalization. The aim of early intervention in first-episode psychosis is the shortening of the course and decreasing the severity of an initial psychotic episode, which by turn minimizes many complications following untreated psychosis.

Cite as: Cutting Edge Psychiatry in Practice 2011, 1(1):41-45; https://doi.org/10.65031/czfc2554

References

  1. McGorry PD, Killackey E, Yung A: Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry. 2008; 7(3):148-56. WHO Declaration on Mental Health in Europe 2004. https://doi.org/10.1002/j.2051-5545.2008.tb00182.x
  2. McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, Jackson HJ. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull. 1996; 22(2):305-26 https://doi.org/10.1093/schbul/22.2.305
  3. Johnstone EC, Frith CD, Crowe TJ, Owen D, Done D, Baldwin E, Charlette A: The Northwick Park Functional Psychosis Study; Diagnosis and Outcome. Psychological Medicine 1992; 22:331-346. https://doi.org/10.1017/s0033291700030270
  4. Cullberg J, Levander S, Holmqvist R, Mattsson M, Wieselgren IM.: One-year outcome in first episode psychosis patients in the Swedish Parachute project. Acta Psychiatr Scand. 2002; 106(4):276-85. https://doi.org/10.1034/j.1600-0447.2002.02376.x
  5. Craig TKJ, GaretyP, Power P , RahamanN, Colbert S, Fornells-Ambrojo M et al: The Lambert early onset (LEO) team; randomised controlled trial of the effectiveness of specialized care for early psychosis. BMJ 2004; 329:1067-9. https://doi.org/10.1136/bmj.38246.594873.7c
  6. Agius M, Shah S, Ramkisson R, Murphy S, Zaman R. Three year outcomes of an Early Intervention For Psychosis Service as compared with treatment as usual for first psychotic episodes in a standard Community Mental Health Team-Final Results. Psychiatria Danubina 2007:19;130-138. https://doi.org/10.1016/s0920-9964(06)70462-5
  7. Nordentoft M Petersen L, Jeppesen P, Thorup AA, Abel MB, Ohlenschlaeger J, et al: OPUS: a randomised multicentre trial of integrated versus standard treatment for patients with a first-episode psychosis secondary publication. Ugeskr Laeger: 2006; 168:381-384. https://doi.org/10.1016/s0920-9964(03)80503-0
  8. Zaytseva Y, Ya Gurovich I, Shmukler A.B. Efficacy of an integrated long-term program of management of patients after first psychotic episode in 5-year followup. Psychiatria Danubina, 2009; 21, Suppl. 2 S177 https://doi.org/10.1016/s0924-9338(09)70587-5
  9. Reading B, Birchwood M: Early Intervention in Psychosis: Rationale and Evidence for Effectiveness Disease Management and Health Outcomes, 2005, vol. 13, issue 1, pages 53-63. https://doi.org/10.2165/00115677-200513010-00006
  10. Birchwood M, Todd P, Jackson C: Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl.1998; 172(33):53-9. https://doi.org/10.1192/s0007125000297663
  11. Emsley R, Chiliza B, Schoeman R: Predictors of long-term outcome in schizophrenia. Curr Opin Psychiatry. 2008 Mar; 21(2):173-7. Review. https://doi.org/10.1097/yco.0b013e3282f33f76
  12. Birchwood M: Early intervention and sustaining the management of vulnerability. Aust N Z J Psychiatry. 2000 Nov; 34 Suppl: S181-4. https://doi.org/10.1046/j.1440-1614.2000.00791.x
  13. Arango C, Moreno C, Martínez S, Parellada M, Desco M, Moreno D, Fraguas D, Gogtay N, James A, Rapoport J: Longitudinal brain changes in early-onset psychosis. Schizophr Bull. 2008 Mar; 34(2):341-53. https://doi.org/10.1093/schbul/sbm157
  14. Ziermans TB, Schothorst PF, Schnack HG, Koolschijn PC, Kahn RS, van Engeland H, Durston S.: Progressive Structural Brain Changes During Development of Psychosis. Schizophr Bull. 2010 Oct 7. https://doi.org/10.1093/schbul/sbq113
  15. McGlashan TH: Early detection and intervention of schizophrenia: rationale and research. Br J Psychiatry Suppl. 1998; 172(33):3-6. Review. https://doi.org/10.1192/s0007125000297584
  16. Carpenter WT Jr, Strauss JS.: The prediction of outcome in schizophrenia. IV: Eleven-year follow-up of the Washington IPSS cohort. J Nerv Ment Dis. 1991 Sep; 179(9):517-25. https://doi.org/10.1097/00005053-199109000-00001
  17. Wyatt RJ: “Neuroleptics and the Natural Course of Schizophrenia.” Schizophrenia Bulletin. 1991; 17: 325-351. https://doi.org/10.1093/schbul/17.2.325
  18. Norman RM, Malla AK: Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001; 31(3):381-400. https://doi.org/10.1017/s0033291701003488
  19. Cahn W, van Haren NE, Hulshoff Pol HE, Schnack HG, Caspers E, Laponder DA, Kahn RS: Brain volume changes in the first year of illness and 5-year outcome of schizophrenia. Br J Psychiatry. 2006; 189:381-2. https://doi.org/10.1192/bjp.bp.105.015701
  20. Takahashi T, Suzuki M, Tanino R, Zhou SY, Hagino H, Niu L, Kawasaki Y, Seto H, Kurachi M: Volume reduction of the left planum temporale gray matter associated with long duration of untreated psychosis in schizophrenia: a preliminary report. Psychiatry Res. 2007; 15; 154(3):209-19. https://doi.org/10.1016/j.pscychresns.2006.10.001
  21. Malla AK, Bodnar M, Joober R, Lepage M: Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis. Schizophr Res. 2011; 125(1):13-20. https://doi.org/10.1016/j.schres.2010.09.021
  22. Davidson M, Galderisi S, Weiser M, Werbeloff N, Fleischhacker WW, Keefe RS, Boter H, Keet IP, Prelipceanu D, Rybakowski JK, Libiger J, Hummer M, Dollfus S,López-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rössler A, Kahn RS: Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). Am J Psychiatry. 2009;166(6):675-82. https://doi.org/10.1176/appi.ajp.2008.08060806
  23. Goldberg TE, Burdick KE, McCormack J, Napolitano B, Patel RC, Sevy SM, Goldman R, Lencz T, Malhotra AK, Kane JM, Robinson DG: Lack of an inverse relationship between duration of untreated psychosis and cognitive function in first episode schizophrenia. Schizophr Res. 2009;107(2-3): 262-6. https://doi.org/10.1016/j.schres.2008.11.003
  24. Barnes TR: The Schizophrenia Consensus Group of the British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2011; 25 (5): 567-620. https://doi.org/10.1177/0269881110391123
  25. Perkins DO, Gu H, Boteva K, Lieberman JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005; 162:1785-1804. https://doi.org/10.1176/appi.ajp.162.10.1785
  26. Marshall M, Harrigan S, Lewis S: Duration of untreated psychosis: definition, measurement and association with outcome in The Recognition and Management of Early psychosis: A preventive Approach, ed. By H.J. Jackson and P.D. McGorry (2009); 125-145. https://doi.org/10.1017/cbo9780511576287.009
  27. Drake RJ, Haley CJ, Akhtar S, Lewis SW: Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry. 2000; 177:511-5. https://doi.org/10.1192/bjp.177.6.511
  28. Malla A: The promises and challenges of early intervention in psychotic disorders. World Psychiatry. 2008; 7(3):157-8. https://doi.org/10.1002/j.2051-5545.2008.tb00183.x