JERI proves its worth for early psychosis

The development of psychosis is thought to be due to a combination of acute stress and vulnerability within a person's makeup. The Jorvi Early Psychosis Recognition and Intervention (JERI) project in Finland is an early intervention initiative aimed at at-risk teenagers. The team meets the adolescents (who are between 12 and 20) in their school or home, together with their parents and community co-worker. The aim of the team is to recognise potential risk cases and step in to improve the children's relationships at home, school and in their social lives, reducing stress and improving their functioning. A study of the project published in the journal Early Intervention in Psychiatry found that it improved functioning and overall quality of life and reduced depression, anxiety and pre-psychotic symptoms. The youngsters did not receive any therapy or antipsychotic medication over the course of the study.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/05/090514101944.htm

Early interventions for psychosis

Some people think that there is a critical period - just after people become ill with psychosis - in which the potential exists to intervene and improve the long-term course of the illness. However, there is no evidence that indicates how long early interventions need to be active to prevent a relapse or how long the effects last. A Danish study of 547 patients with first-episode psychosis compared a two-year, intensive, early-intervention treatment made up of assertive community treatment, family involvement and social-skills training to standard treatment. There was an improvement in the early-intervention group after two years but after five years there was no difference between the two group as far as symptoms were concerned. But fewer of the early-intervention group were living in sheltered housing and they had had fewer days in hospital over the 5-year period.

Bertelsen, Mette ... [et al] - Five-year follow-up of a randomized multicenter trial of intensive early intervention vs. standard treatment for patients with a first episode of psychotic illness Archives of General Psychiatry July 2008, 65(7), 762-771

Early intervention for untreated psychosis

The duration of untreated psychosis (DUP) - the time from the onset of psychotic symptoms to the start of adequate treatment - is one of the most important factors in the course of the condition and a shorter DUP has consistently been shown to correlate with a better course and outcome for all the symptoms of psychosis. Researchers in Scandinavia created a comprehensive, early-detection system for psychosis and launched a public information campaign in one area, and compared it to another area without early detection. The first-episode patients from the early-detection area had significantly lower DUP, better clinical status and milder negative symptoms at the start of the treatment. After a year there was still a difference in negative symptoms between the groups. After two years there were still differences in negative symptoms, depression and cognition between the two sets of patients.

Melle, Ingrid ... [et al] - Prevention of negative symptom psychopathology in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis Archives of General Psychiatry June 2008, 65(6), 634-640

Detection and untreated psychosis

People suffering from their first episode of psychosis often experience long periods of untreated psychosis before coming into contact with psychiatric services. The duration of untreated psychosis (DUP) averages 1-2 years but the longer DUP is the worse people's prognosis. An early detection programme and a comprehensive information campaign have been shown to be effective in reducing DUP. A Danish study of 552 people looked at what happened in Copenhagen where an early detection team was established in 1998 without an accompanying information campaign. The study found that the mean DUP was a year and that the early-detection team on its own had had no effect in reducing it. However, more people who had some symptoms of psychosis, without the full-blown disorder, had been referred for treatment.

Nordentoft, Merete ... [et al] - Does a detection team shorten duration of untreated psychosis? Early Intervention in Psychiatry 2008, 2, 22-26

Early intervention for psychosis - long-term effects

Psychotic disorders lead to an increased risk for suicide, particularly during the early course of the illness. Up to a third of first-episode psychosis patients attempt suicide prior to commencing treatment and as many as 15% do so in the first 1-2 years of treatment. Early intervention and treatment for psychosis is, therefore, seen as very important. An Australian study of 7,760 people with psychosis aged between 15 and 29 found that 8.5 years after treatment there was no difference in suicide rates between those who had and had not received early intervention. However, after adjusting for other socio-demographic, clinical and treatment factors suicide risk was lower by 50%, in the first three years after treatment, for the group who had received early intervention. A history of inpatient treatment, more days of treatment per annum and a shorter time to establish a psychiatric diagnosis were all associated with an increased risk of suicide. People who weren't working but who weren't looking for a job either were at less risk than those who were unemployed and looking for work.

Harris, Meredith G. ... [et al] - Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study Early Intervention in Psychiatry 2008, 2, 11-21

Predicting psychosis in high-risk youth

A study of 325 youngsters in the U.S. has found that those who have a combination of different risk factors for the condition have a 65-80% chance of going on to develop full-blown psychosis. The researchers who conducted the study claim that an understanding of these combinations could help scientists predict who is likely to develop the illness within two to three years with the same accuracy that other kinds of risk factors can predict major medical diseases, such as diabetes. 35% of people with the accepted criteria for being at risk of psychosis go on to develop the illness but the figure rises to 65-80% with the following combination of risk factors :

• deteriorating social functioning (e.g. spending increasing amounts of time alone in one's room)
• a family history of psychosis combined with a recent decline in functioning e.g. a drop in school marks or a withdrawal from extracurricular activities)
• an increase in unusual thoughts (e.g. thinking strangers' conversations are about one's self)
• an increase in suspicion/paranoia
• past or current drug abuse

The researchers also found that those who progressed to a psychotic disorder tended to do so relatively quickly. 22% developed psychosis within the first year, 11% by the end of the second year and the remaining 3% by the end of 2 1/2 years.

You can find out more about this research at

http://psychcentral.com/news/2008/01/08/predict-psychotic-illness-in-high-risk-youth/1757.html