General Resources / Legal Resources / Medical Resources / Briefing Papers / State Activity    
Hospital Closures / Preventable Tragedies / Press Room / Search Our Site / Home

Early intervention, untreated psychosis and the course of early schizophrenia.

Linszen D, Lenoir M, de Haan L, Dingemans P, Gersons B (1998).

British Journal of Psychiatry 172 (Suppl 33): 84-89.

Results from a previous study by these authors had shown that an intensive 15-month early intervention program improved the course of illness for individuals with recent-onset schizophrenia. In this follow-up study, however, the authors found that the benefits of this intervention did not last once patients had been referred to other mental health agencies. The favorable effects of the early and intensive treatment disappeared rapidly, suggesting that the only way to prevent poor outcome in schizophrenia seems to be the continuation of medication compliance, stress management, and case management for an as yet unknown critical period.

A previous study by these authors had shown that, in a group of patients with recent-onset schizophrenia, an intensive early intervention program had a beneficial effect on relapse and the course of psychosis, which lasted until the end of the 15-month period. Treatment consisted of an initial inpatient hospitalization which included psychoeducation for patients’ relatives, followed by outpatient treatment with a day hospital and community care. Seventy-six patients completed both the inpatient and outpatient phases of the clinical trial (55 percent had schizophrenia, 21 percent schizoaffective disorder, 13 percent schizophreniform disorder, and 11 percent other psychotic disorders such as delusional disorder and atypical psychosis). Half the group randomly received a year-long behavioral family intervention program combined with the patient-oriented psychosocial intervention (including antipsychotic medications) that all patients received. All patients were between the ages of 15 and 26 and were in close contact with their parents or other relatives. During the 15-month period, relapse rate was equally low (15 percent) for both groups. No differences were found in relapse rate or clinical course for those patients who received the additional family intervention.

This study was a follow-up of the initial one, and lasted 17 to 55 months. Seventy of the initial 76 patients completed the follow-up. Relapse, clinical symptomatology, and medication compliance were assessed for all patients. The authors found that the benefits conferred by the early intervention in the first study did not last. Fifteen percent of the group had relapsed during the 15 month intervention, whereas 64 percent had relapsed during follow-up. Duration of untreated psychosis did not predict the course of the illness, although only 12 individuals had a duration of untreated psychosis lasting more than one year.

The main conclusion drawn from the initial study was that an early, intensive intervention that included both treatment with antipsychotic medications and a psychosocial treatment program had a favorable effect on the course of schizophrenia. The results from this follow-up study, however, suggest that referral to other mental health agencies after early intervention is not sufficient, and that early benefits may disappear rapidly if not continued. Thus, more support is required to continue disease management, medication compliance, and stress management for an as yet unknown critical period.

General Resources / Legal Resources / Medical Resources / Briefing Papers / State Activity   
Hospital Closures / Preventable Tragedies / Press Room / Search Our Site / Home