Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Is early intervention advisable?
- Sahoo Saddichha, Hyderabad, India (8 August 2008)
-
EI approach not services is the answer
- Eileen E O'Sullivan (5 April 2009)
|
|
|||
|
Sahoo Saddichha, Partner, Department of Applied Research, Emergency Management and Research Institute, Hyderabad, India
Send response to journal:
|
Early intervention in psychiatric disorders is of immense benefit in improving functioning and improving the long-term course of the disorder [1-3], while demonstrating higher relative rates of therapeutic response and symptom remission [4]. On the other hand, fears of adverse effects on metabolic profile and development of Metabolic syndrome [5-6] are also a reality today due to the indiscriminate use of antipsychotics, especially the atypical drugs. It is indeed the dream of every practicing psychiatrist to be able to intervene early as McGorry has argued for, given the criteria assessing risk factors and psychotic symptoms [7]. Unfortunately, such criteria lack evidence to back themselves and are as such not universally accepted. In addition, I believe that substance use and suicidal attempts are also significant trait/state risk factors that could determine early onset of psychosis [8]. I however agree that recent reviews may have been too conservative to detect actual benefits and that reduction of stigma, not just by the community, but also by health workers [9] could also go a long way in improving outcomes. On the other hand, Pelosi [10] warns us of the dangers of over- treatment which is entirely justified, given the fact that many of these drugs have long lasting adverse effects. I was however unable to share his enthusiasm about “potentially dangerous psychotherapy”, the “adverse” effects of which I am ignorant about. In fact, the use of drugs to treat individuals, arguing for non-existent illnesses, has reached epidemic proportions giving rise to what some critics are calling disease mongering [11]. I would therefore advocate patience before strict operational criteria are developed in order to intervene early. References: 1. Waddington JL, Buckley PF, Scully PJ, et al. Course of psychopathology, cognition and neurobiological abnormality in schizophrenia: developmental origins and amelioration by antipsychotics? J Psychiatr Res. 1998;32(3–4):179–189. 2. Haas GL, Garratt LS, Sweeney JA. Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res. 1998;32(3–4):151–159. 3. Birchwood M, Todd P, Jackson C. Early intervention in psychosis: the critical period hypothesis. Br J Psychiatry. 1998;S172(33):53–59. 4. Robinson DG, Woerner MG, Alvir JMJ, et al. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry. 1999;156:544–549. 5. Saddichha S, Manjunatha N, Ameen S, Akhtar S. Effect of Olanzapine, Risperidone, and Haloperidol Treatment on Weight and Body Mass Index in First-Episode Schizophrenia Patients in India: A Randomized, Double-Blind, Controlled, Prospective Study. J Clin Psychiatry 2007;68(11):1793-96. 6. Saddichha S, Manjunatha N, Ameen S, Akhtar S. Metabolic syndrome in first episode schizophrenia- A randomized double-blind controlled, short- term prospective study. Schizophrenia Research 2008; 101(1-3):266-72. 7. McGorry PD. Is early intervention in the major psychiatric disorders justified? Yes. BMJ 2008 337: a695 8. Saddichha S. Catch them early for best outcome Re: Bryne P. Managing the acute psychotic episode BMJ 2007; 334: 686-692 available at http://www.bmj.com/cgi/eletters/334/7595/686#163511 9. Vibha P, Saddichha S, Kumar R. Attitudes of ward attendants towards mental illness: Comparisons and predictors. International Journal of Social Psychiatry 2008 (in press). 10. Pelosi A. Is early intervention in the major psychiatric disorders justified? No. BMJ 2008;337:a710 11. Moynihan R, Cassels A (2005) Selling sickness. How the world's biggest pharmaceutical companies are turning us all into patients. New York: Nation Books. 254 p Competing interests: None declared |
|||
|
|
|||
|
Eileen E O'Sullivan, Consultant Psychiatrist Assertive Outreach Long Fox Unit, Weston Super Mare, BS23 4TQ
Send response to journal:
|
I agree with Dr Pelosi's stance, but would concede that the contribution of McGorry and colleagues has been to direct necessary attention to the needs of young people and families experiencing the symptoms of mental distress. Mercifully only a small proportion go on to develop severe mental illness, but the needs of this group have not been well served by services in the past. This had to be rectified - and is well on the way to being so. Now the early intervention approach should be integrated into the generic community mental health team -(as should the assertive outreach approach!), and EI and AO teams should be disbanded, with the funding reinvested into community teams. Using the recently introduced community scorecard, the "approach" could be monitored and embedded in community team practice. This will improve provision for a greater number of people, and avoid the all too common practice of "closing" caseloads, and restricting access to an exact patient profile. As for interventions directed at possibly prodromal symptoms, it would be better for innovative, research orientated centres to identify 1.preventative work in schools which increases resilience, 2.credible (to young people) information on drugs and alcohol, 3.ways to decrease the reluctance and stigma associated with accessing help, and 4.a range of youth friendly, acceptable resources and services. These measures, rather than EI Teams, should be funded by PCTs, LEAs and LAs. Competing interests: I work in a mental health service plagued by diversion of monies to specialist teams |
|||