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Problems with early and very early intervention in psychosis.

Warner R

University of Colorado, and Mental Health Center of Boulder County, 1333 Iris Avenue, Boulder, CO 80304, USA. drdickwarner@aol.com

"Early intervention" can refer to two different approaches--intervention when the psychosis is already evident and intervention before a psychosis is fully apparent. Each carries a distinctly different set of risks. The hoped-for benefits of early intervention in a fully evident psychosis are based on research that reveals an association between intervention early in the illness and good outcome. Those suffering from a psychosis of recent onset, however, are more likely to experience a spontaneous remission of illness, and this may readily explain the observed association. Early intervention in such cases of good-prognosis psychosis may lead to unnecessary and, sometimes, protracted treatment for those who would do well with no treatment. Intervention in the supposed prodromal phase of psychosis presents more serious hazards. The screening instruments currently available are inadequate for the accurate prediction of psychosis, and the risks of negative effects for the large numbers of people who screen false-positive are considerable. These risks include unnecessary fear of illness, restriction of life goals, use of medication and their side-effects.

Published 1 August 2005 in Br J Psychiatry Suppl, 48: s104-7.
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