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The impossible dream: can psychiatry prevent psychosis?
Author(s) -
Lieberman Jeffrey,
Corcoran Cheryl
Publication year - 2007
Publication title -
early intervention in psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.087
H-Index - 45
eISSN - 1751-7893
pISSN - 1751-7885
DOI - 10.1111/j.1751-7893.2007.00031.x
Subject(s) - dream , psychiatry , psychosis , psychology , psychotherapist , medicine
Few things have captured the attention of the field of psychiatric research and mental health care more than the prospect of early detection of schizophrenia and intervention during its premorbid or prodromal stages to prevent its onset. Adding to the enthusiasm is the fact that this goal seems achievable and could potentially dramatically limit the consequences of the illness if not reduce the incidence of psychotic disorders. However, while the future prospect for early intervention in schizophrenia is excellent, the present is a challenge, and we have our work cut out for us. Although current efforts to reduce the duration of untreated psychosis is an unalloyed good, with reduction in suicide and preservation of function, intervention during a prepsychotic prodromal phase in schizophrenia remains controversial. The current debate over mental health parity in the USA is illustrative. The greatest objection to equity in coverage and reimbursement of care of mental illness in the USA is the claim that ‘mental health care is often entirely disconnected from evidence’, despite an evidence base for the treatment of many disorders (Azalavitz, 4/11/07, NY Times Op-Ed). For prevention of mental illness, the evidence base is as yet still in a nascent stage. Therefore, although there is a groundswell of international interest in early intervention in psychiatry, we must remain sceptical in our beliefs and rigorous in our approaches, systematically evaluating potential strategies and only promoting those that are clearly supported by evidence. We have a golden opportunity that we cannot squander. Three essential elements are necessary to establish early detection and intervention as the standard of care and enable its acceptance into clinical practice: (i) reliable and accurate diagnostic methods for case identification; (ii) proven methods of intervention; and (iii) the development of models of service delivery. Each of these is reviewed in turn. DIAGNOSTIC METHODS FOR CASE IDENTIFICATION