• Corpus ID: 14646239

Improving outcome in schizophrenia: the case for early intervention.

  title={Improving outcome in schizophrenia: the case for early intervention.},
  author={Ashok K. Malla and Ross M G Norman and L. P. Voruganti},
  journal={CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne},
  volume={160 6},
  • A. MallaR. NormanL. Voruganti
  • Published 23 March 1999
  • Psychology, Medicine
  • CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
The long-term course of schizophrenia, one of the world’s most serious public health problems, is generally regarded as one of chronicity and disability. Despite the availability of treatment, more than 50% of patients continue to exhibit moderate levels of “positive symptoms” such as delusions, hallucinations, and disorganized thinking and behaviour, and “negative symptoms” such as poverty of thought, volition and affect, and social and interpersonal withdrawal, and require long-term support… 

First-episode psychosis: psychopathology, quality of life, and functional outcome.

The findings from longitudinal studies of the dimensional psychopathology of first-episode psychosis suggest continuity of some psychopathological dimensions from premorbid through prodromal to post-onset phases of psychosis and some aspects of longer-term course.

Predicting the onset of schizophrenia

The longer the start of an efficient therapy is delayed after the onset of first psychotic symptoms, the longer the ‘Duration of Untreated Psychosis’ (DUP), the more likely a negative clinical course becomes with regard to different outcome measures.

Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia

Testing models of the early course of schizophrenia

Not only a detailed characterization of the symptoms and disturbances of the initial prodrome but also a study of the evolution of prodromal to psychotic symptoms are necessary.

Duration of untreated psychosis: a critical examination of the concept and its importance

Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse.

Early intervention in schizophrenia and related disorders: advantages and pitfalls

Clinicians should concentrate on providing phase specific treatment early following the onset of psychosis and wait for more definitive evidence regarding the application of interventions in the pre-psychotic phase of the illness.

Treating Psychosis: Is There More to Early Intervention Than Intervening Early?

  • Ashok M MallaR. Norman
  • Psychology, Medicine
    Canadian journal of psychiatry. Revue canadienne de psychiatrie
  • 2001
The 2 aspects of early intervention—integration of phase-specific treatments and early case identification—need to go hand in hand to ensure that another opportunity will not be missed in the authors' efforts to improve the outcomes of these most serious of all mental disorders.

Improving outcomes for patients with schizophrenia: new hope for an old illness.

  • M. Seeman
  • Psychology, Medicine
    CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
  • 1999
There is new evidence that brain impairment, as reflected by structural neuroimaging or neuropsychological assessment, is present by the time of initial diagnosis, and there is cause to believe that this early brain impairment does not appreciably worsen over time.

Duration of untreated psychosis and cognitive functioning in first-episode patients

Findings do not provide support for a toxic effect of DUP on cognitive functioning, and other mechanisms through which DUP might affect outcome such as psychological engulfment, social support and adherence to medication are discussed.

Reducing the duration of untreated first-episode psychosis: effects on clinical presentation.

It is possible to reduce the DUP for first-episode patients in a defined health care area through the introduction of an early detection (ED) program, compared with parallel health care areas without an ED program (No-ED).



The Varied Outcomes of Schizophrenia

The early appearance and stability over time of negative symptoms and cognitive impairments call for assertive intervention efforts early in the course of disorder to prevent chronicity and prolonged disability.

The Prediction of Outcome in Schizophrenia IV: Eleven‐Year Follow‐Up of the Washington IPSS Cohort

Follow-up data suggest that the illness tends to reach a plateau of psychopathology early in the course, with as many patients tending to improve in the long-term as those who tend to show further deterioration.

Characteristics of outcome in schizophrenia at 13 years.

A 13-year outcome of an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia is described, finding Kraepelin's emphasis on the longitudinal implications of a diagnosis of schizophrenia are supported, but may be over-pessimistic.

Gender and the course of schizophrenia: differences in treated outcomes.

When confounding factors were controlled for, schizophrenic women showed a better course of hospital treatment, experienced a shorter length of hospital stay, and survived longer in the community after their first hospital admission.

Duration of psychosis and outcome in first-episode schizophrenia.

Duration of psychosis before treatment may be an important predictor of outcome in first-episode schizophrenia, and is significantly associated with time to remission as well as with level of remission.

First-episode schizophrenia: I. Early course parameters.

Early course parameters of a Norwegian first-episode sample demonstrated strong gender differences, with male patients having significantly higher frequency of single marital status, lower educational status, schizophrenia, early age at onset, and lower Global Assessment of Functioning scores the last year before hospitalization.

One hundred years of schizophrenia: a meta-analysis of the outcome literature.

Overall, less than half of patients diagnosed with schizophrenia have shown substantial clinical improvement after follow-up averaging nearly 6 years, despite considerable gains in improvement rates after mid-century, there has been a decline since the 1970s.

A selective review of recent North American long-term followup studies of schizophrenia.

North American outcome studies of schizophrenia conducted within the past quarter century are reviewed if their minimum average followup is 10 years and they meet at least some modern design criteria and support a broad definition of schizophrenia.

National Institute of Mental Health longitudinal study of chronic schizophrenia. Prognosis and predictors of outcome.

Level of positive and negative symptoms ascertained when patients received optimal neuroleptic treatment during the index hospitalization significantly predicted outcome levels of symptoms and functioning and time spent hospitalized during the follow-up period, suggesting that treatment response is a critical predictor variable for the course of illness in schizophrenics.