Early Interventions in Psychotic Disorders: Need for Regional Adaptations
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EDITORIAL
Early Interventions in Psychotic Disorders: Need for Regional Adaptations Jagadisha Thirthalli
Received: 7 October 2020 / Accepted: 9 October 2020 Ó Springer Nature India Private Limited 2020
Up to about three-fourths of patients experiencing their first episode of schizophrenia or related psychotic disorders achieve clinical remission within 1 year of initiating treatment [1]. Yet, schizophrenia is one of the leading causes of disability. Long-term outcome of this condition has remained deplorably poor. It is so across several dimensions of outcome, including employment, marriage, independent living, mortality in general, and, by suicide in particular. What explains this vast gap between relatively good short-term outcome and poor long-term outcome? Finding answer to this question may help in improving the long-term outcome.
this phase, explaining as to why this period plays a crucial role in determining long-term outcome of psychoses [3]. After this period, the change in the course of illness is relatively less pronounced. If deterioration occurring during the critical period is somehow averted, then, one might expect to improve the long-term course and outcome of schizophrenia. Conversely, not initiating comprehensive care during this period may underlie the poor long-term outcome. This thinking has led to the development of several programs aiming at providing comprehensive care early in the course of psychotic disorders.
Early Interventions The ‘Critical Period’ In the past few decades, the concept of ‘critical period’ in the course of psychotic disorders has been influential. According to this, overall deterioration happens maximally during the beginning years of the onset of psychosis [2]. Several poor prognostic factors as well as neurobiological changes seem to accumulate during
J. Thirthalli (&) Psychiatric Rehabilitation Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India e-mail: [email protected]; [email protected]
In a broad sense, early interventions refer to (a) interventions that aim to prevent the development of psychoses among persons described to have high risk to develop psychosis, (b) programs that are aimed at reducing the duration of untreated psychosis (DUP) and (c) interventions that provide comprehensive care at the first instance of treatment, with or without specific efforts to reduce DUP. Comprehensive care referred to in the latter generally includes interventions designed to address specific needs of individuals going through early phases of schizophrenia, namely, medication management, ensuring continuity of care, access to welfare benefits, case management, support towards social, educational and vocational goals and
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J. Psychosoc. Rehabil. Ment. Health
engaging families in the care of the individual with psychosis. These approaches have shown promise in the short run—those who received such care experienced significantly better outcomes at the end of follow up periods of up to about 5 years than those who recei
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