Early intervention in psychosis may prevent or limit clinical, social, occupational and psychological deterioration. This has been a captivating theoretical notion for some time. Recently, it has been the subject of several influential international conferences, and services dedicated to early intervention are being set up throughout the world. This is the first book to describe the theory and clinical utility of early intervention in detail. It reports largely on the pioneering work of a group based in Melbourne, Australia, although other important contributions from researchers in the USA, UK and Holland are included.
The book is wide-ranging in its analysis. It is divided into four sections, which cover: the concept of early psychosis and its implications for treatment; the ways in which people suffering from psychosis may first present to services, their pathway to care, case detection and the consequences of delay; the assessment and clinical management of early psychosis; and the development of new services and reform of existing services to embrace the new paradigm.
Overall, the book indicates that assessment and intervention for early psychosis must be comprehensive and integrated, with equal attention paid to biological, psychological and social factors. The various authors argue that effective early intervention requires a collaborative alliance with the (usually) young sufferer and their family, awareness of the life-stage of the sufferer (with individuation and autonomy given particular prominence), awareness of comorbidity (particularly depression, hopelessness and substance misuse) and encouragement of user involvement in service delivery and development. Clear guidelines in the form of a three-step model, are described for those considering setting up an early intervention service.
The text does much to dispel the pessimism and therapeutic nihilism associated with schizophrenia. However, Patrick McGorry, one of the leading innovators in the early intervention movement, warns against overenthusiasm in applying early intervention principles. He acknowledges the need for continued rigorous empirical research to support the burgeoning clinical data which indicate that early intervention in psychosis can reduce the time individuals spend trying to access mental health services (and hence time spent in untreated psychosis) and improve, or at the very least, prevent further deterioration in, psychosocial functioning. Furthermore, long-term studies are needed to demonstrate the cost-effectiveness of early intervention.
This is an excellent, clearly written text, liberally interspersed with informative case studies and clear diagrams which help to illustrate conceptual issues. I can whole-heartedly recommend it to all mental health professionals working with those suffering from severe and enduring mental health problems. Those who work with more chronic sufferers are also likely to find the developmental issues and psychological approaches covered of considerable interest.
The book is a testament to the visionary and tireless work of the Melbourne group. I am sure it will become a classic text and do much to inspire other workers to set up early intervention programmes and hence play a part in helping to ease the plight of young people with psychosis. In my opinion, no department of psychiatry or clinical psychology, or community health team, should be without a copy.
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