Published 4 August 2008, doi:10.1136/bmj.a695
Cite this as: BMJ 2008;337:a695

Head to Head

Is early intervention in the major psychiatric disorders justified? Yes

¹ ORYGEN Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria, 3052, Australia

Psychiatric disease can take many years to emerge fully. Patrick McGorry argues that early specialist treatment is essential, but Anthony Pelosi (doi: 10.1136/bmj.a710) is unconvinced that current evidence of benefit is enough to balance the potential harm

The first 150 words of the full text of this article appear below.

Early diagnosis and treatment is intuitively appealing and widely accepted in medicine. Over the past 15 years, early intervention has become established in psychotic disorders and must now be extended to other mental disorders. Early intervention covers both early detection and the phase specific treatment of the earlier stages of illness with psychosocial and drug interventions. It should be as central in psychiatry as it is in cancer, diabetes, and cardiovascular disease.

Evidence for early intervention

Mental illnesses have been called the chronic diseases of the young.¹ The incidences of mood, anxiety, psychotic, personality, eating, and substance use disorders are highest in adolescence and early adult life.² Serious mental disorders increase mortality and may produce decades of disability and unfulfilled lives. Thus, the potential benefits and cost effectiveness of early intervention in mental disorders arguably exceed those for medical diseases, which typically emerge later in life.

Early clinical features can be difficult to distinguish . . . [Full text of this article]

Criteria to identify patients at very high risk of psychosis or with full threshold psychosis⁴
Very high risk
Group 1: Trait and state risk factors
Group 2: Subthreshold psychotic symptoms
Group 3: Brief limited intermittent psychotic symptoms
Full threshold psychosis

Solutions for cost effective and humane care

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