Early intervention in psychosis: the critical‐period hypothesis

@article{Birchwood1998EarlyII,
  title={Early intervention in psychosis: the critical‐period hypothesis},
  author={Max Birchwood and Pauline Todd and Chris Jackson},
  journal={International Clinical Psychopharmacology},
  year={1998},
  volume={13},
  pages={S31–S40}
}
The early phase of psychosis may be considered as a critical period that offers major opportunities for secondary prevention of impairments and disabilities accompanying psychosis. Prospective studies of first-episode schizophrenics support the critical period hypothesis and indicate that progression, where it occurs, does so early in the disorder, with patients reaching a relatively stable plateau within 2 years of the first psychotic episode. This suggests a window of opportunity for… 
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References

SHOWING 1-10 OF 80 REFERENCES
Early Intervention in Schizophrenia
TLDR
Vigorous intervention early in the course of illness, early recognition and treatment of relapse and the promotion of psychological adjustment to psychotic illness are proposed as key elements of this third paradigm of “early intervention”.
Early Intervention in Psychotic Relapse: Cognitive Approaches to Detection and Management
TLDR
The research on prodromal signs is reviewed, with three areas of focus: prodromes as continuous versus discrete phenomena, sensitivity and specificity, and early intervention studies.
Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial
TLDR
The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and ‘low level’ psychotic thinking, Nevertheless this kind of ‘clinical’ recovery required a median of 20 weeks to complete.
Cognitive behavioural therapy for drug-resistant psychosis.
TLDR
Cognitive behaviour therapy was offered to patients with a diagnosis of schizophrenia or schizo-affective psychosis who presented unremitting positive symptoms who improved significantly on a number of key symptom measures when compared with the controls.
The role of social relationships in the course of first-episode schizophrenia and affective psychosis.
TLDR
While involvement with family members also predicted good prognosis among subjects with affective psychosis, family involvement had a negative association with outcome among schizophrenic subjects.
Expressed emotion and early onset schizophrenia: a one year follow-up.
Key relatives of 33 first or early admission psychotic patients (mainly schizophrenics) were interviewed to determine household levels of expressed emotion (EE). The patients were followed up for 12
Posttraumatic Stress Disorder Following Recent‐Onset Psychosis An Unrecognized Postpsychotic Syndrome
TLDR
Clinical experience with psychotic patients early in the course of their illness suggested that symptoms of posttraumatic stress disorder (PTSD) may not be uncommon after recovery from an acute psychotic episode, and the prevalence of PTSD was found to be 46% at 4 months and 35% at 11 months.
The natural course of schizophrenia: a review of first-admission studies.
TLDR
Methodological improvements in first-admission research are suggested, including separating the analyses of first-episode patients from those with past psychotic experiences, employing longitudinal methods for deriving diagnosis, and enlarging the samples either by multisite or multicenter collaborations or by pooling data across studies.
Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial
TLDR
CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms.
Further Investigation of the Predictors of Outcome Following First Schizophrenic Episodes
TLDR
Good occupational outcome in patients with a relatively short pre-treatment duration of illness was associated with the prescription of placebo medication during the follow-up period and with more ‘neurological soft signs'.
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