Early Treatment of Schizophrenia Patients Results in Greater Response to Antipsychotic Treatment
For many years, a debate has raged among psychiatrists over whether or not early intervention after a schizophrenia patient's first episode of psychosis could improve the person's long-term outcome.
A study led by University of North Carolina at Chapel Hill researchers, and reported in the October issue of the American Journal of Psychiatry, concludes that early intervention can improve outcome. In addition, last month the department of psychiatry in UNC's School of Medicine launched a new program that is based on the study's results and aims to provide early treatment to adolescents and young adults after their first episode of psychosis.
Historically, the prevailing view has been that "it just doesn't matter when you treat a person because their clinical outcome is predetermined," said Dr. Diana O. Perkins, a professor in the department of psychiatry and the lead author of the study.
The historical view, which holds that schizophrenia is the result of altered brain development that begins before a person is born and that treatment will not improve long-term outcome, is often referred to as the "doomed from the womb" theory. Many psychiatrists still adhere to this view, Perkins said, but more recent studies suggest that early intervention can improve outcome.
This question of whether or not early intervention influences outcome has been very controversial within the field of psychiatry, Perkins said. "There have been debates about it at nearly every meeting I go to," she said.
To shed new light on the question, Perkins and colleagues performed a systematic meta-analysis of data from previously published studies addressing the question, "Does prolonged duration of untreated psychosis influence outcome?"
It's well known that with many medical conditions, the longer someone is left untreated, the worse off that person is going to be, and the sooner they receive treatment, the better off they'll be. Perkins and colleagues set out to discover whether an analogous process was at work in people with schizophrenia.
To answer this question, the researchers initially reviewed 625 previously published studies. Of these, 43 were found to be best suited for answering their research question. The data from these studies were then subjected to systematic statistical analysis.
Their study found that shorter duration of untreated psychosis was associated with greater response to antipsychotic treatment. In other words, early treatment did lead to improved outcomes.
In addition, "the longer someone was untreated, the less well they were doing in terms of clinical symptoms and functional outcomes, immediately after treatment and as long as 15 years out," Perkins said.
These results show that "schizophrenia doesn't have to be a disabling disorder," she said. "At least in some people, symptomatic and functional disability may be preventable."
Schizophrenia is a chronic, recurrent mental illness, characterized by hallucinations, delusions and disordered thinking. It affects 3.2 million Americans, or about 1 percent of the population, making it as common as type 1 diabetes, Perkins said.
"It is also one of the most disabling disorders," Perkins said, "accounting for more disability dollars than any other disorder. So it's expensive, both in terms of personal cost for individuals and in terms of financial cost for society."
In September, Perkins and a multidisciplinary team in UNC's department of psychiatry launched a new program aimed at providing early treatment to adolescents and young adults after their first episode of psychosis. The new program, called OASIS (Outreach and Support Intervention Services), is unique in the United States in its emphasis on tailoring early identification and treatment to young people and their families at the start of a psychotic disorder, Perkins said.
UNC's OASIS program is modeled after early psychosis programs in Australia, England, Canada and Norway. These programs have shown remarkable positive outcomes, including avoidance of hospitalization for many participants, sustained long-term remission of symptoms and the resumption of normal school or work activities, Perkins said.