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Article Index
Earlier Detection and Intervention in Schizophrenia: Unsolved Questions
What Are the Earliest Signs and Symptoms of Schizophrenia?
Which Factors Influence the Duration of Untreated Psychosis (DUP)?
Do Early Detected Patients Need Special Treatment?
All Pages

Schizophrenia Bulletin, Vol. 22, No. 2, 1996
National Institute of Mental Health

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Abstract

Secondary prevention in schizophrenia is still not good enough, and the authors of the articles in this issue of Schizophrenia Bulletin present important new knowledge that may increase earlier detection and treatment. This final article discusses some of their main findings in relation to clinical consequences and new research. We need more knowledge about the clinical characteristics of the prodromal phase and about the factors that influence the help-seeking behavior of patients and families in the early phases of schizophrenia. The new models presented for early detection and treatment are promising and should be replicated in other countries and on other continents.

Schizophrenia Bulletin, 22(2): 347-351, 1996.

Because we still lack an effective primary prevention of schizophrenia, we need to make great efforts to improve our secondary prevention. As long as this disorder persists as one of our most costly medical disorders -- economically as well as in terms of human suffering - any clinically significant reduction in the severity and/or duration of schizophrenia is surely worth any investment.

Theoretically, secondary prevention is improved if we can apply a more effective treatment at an earlier point in the course of most disorders. For schizophrenia, there is some empirical evidence, although inconclusive, that this is the case. The work to improve the secondary prevention of schizophrenia will therefore have two aims: to find strategies and methods for earlier detection and to develop treatment methods and programs that are tailor-made for patients in the early phases of schizophrenia.

What kind of knowledge do we skill need to reach these aims? Concerning earlier detection, we obviously need to know more about the very early signs and symptoms indicating the development of a schizophrenic disorder with a reasonably high degree of probability. We also need to know the biological, psychological, and social factors that influence the treatment-seeking behavior of subjects in the earlier phases of schizophrenia. Although the earliest signs and symptoms of schizophrenia may be universal and thereby easily generalizable, treatment-seeking behavior may be differently influenced by individual, family, social, and health service factors in different cultures and countries. Therefore, general knowledge about the most influential factors on treatment seeking must be based on studies from different countries and continents.

Concerning early treatment intervention, we need to know whether the treatment modalities that have a significant impact on schizophrenia patients under the usual treatment-seeking situation, such as psychopharmacological, psychoeducational, and assertive outreach programs (Lehman et al. 1995), can be applied with the same or better results and without modifications to an earlier detected group. We should also explore whether patients detected earlier may benefit even more from other interventions. It is also important to prove empirically that an early intervention by itself is more beneficial for the patients and their families than a later one. These questions should be explored by comparing earlier and later detected patients who receive the same treatment program, at least concerning the core elements. We are in fact initiating such a prospective study in Norway in collaboration with Danish and American groups.

Several of the research questions mentioned here are addressed by the contributors to this issue of the Schizophrenia Bulletin. In this final article, I will summarize and discuss some of the answers that these authors have given to these questions. I will also indicate some clinical consequences of the findings, and some research questions that should be studied further.

Disorders - Schizophrenia