The early detection and treatment controversy in schizophrenia research

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Purpose of reviewOver the last decade, a growing interest in early intervention in psychosis has been generated by studies suggesting that early treatment might improve the outcome for subjects with psychotic disorders. However, a large number of questions remain unanswered regarding the usefulness of early intervention programmes. The aim of this paper is to review the recent literature on early intervention.Recent findingsThe most important findings supporting early intervention are those obtained in a population-based study demonstrating that educational campaigns may help to reduce the duration of untreated psychosis, together with those obtained in a randomized, controlled trial study showing that transition rates were lower in subjects with at-risk mental states treated with low doses of antipsychotic drugs and cognitive therapy than those in subjects treated with supportive psychotherapy. However, the existence of a causal link between duration of untreated psychosis and outcome, the case definition of ‘prodromal psychosis with need of care’, and the risk of early intervention for the subjects with prodromal psychosis are not completely established. From a public health perspective, the adequacy of screening tests, the target population, and the risks and benefits of early intervention for the target population are also unclear. There is also a growing concern regarding the ethical questions raised by early intervention research.SummaryCurrent evidence is insufficient to clarify whether early intervention programmes for psychotic disorders are useful. More research is needed to provide relevant answers to the unsolved questions regarding the usefulness and efficacy of early intervention in psychosis.

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