What is meant by the old saying “Prevention is better than cure?” This saying holds great significance in the context of early intervention (EI) services for psychosis. These services offer tailored, multi-disciplinary outpatient care to individuals presenting with a first episode of psychosis. Early intervention (EI) has been shown to improve symptom severity, reduce the number of hospitalizations, and increase societal functioning, such as work and study. However, the long-term effectiveness of early intervention has been a topic of debate, with several studies showing short-lived effects.
A recent study by Hansen et al. (2023) aimed to address this debate by conducting a 20-year follow-up of a randomized controlled trial comparing early intervention for psychosis with mental health community treatment as usual (TAU). The original trial enrolled 547 individuals with a first-episode schizophrenia spectrum disorder, who were randomly assigned to receive either early intervention or TAU. The 20-year follow-up included assessments of diagnosis status, symptoms of psychosis, everyday functioning, cognitive functioning, and quality of life.
The results of the 20-year follow-up showed that there were no long-term differences between individuals receiving early intervention and those receiving treatment as usual. Mortality rates and employment status were similar between the two groups. The study also highlighted the alarmingly high mortality rate among individuals with psychosis, emphasizing the need for improved prevention and treatment of physical comorbidities and suicidal behavior.
The strengths of this study include the long-term follow-up period and the use of national registries for outcome measures that are often difficult to obtain. However, the high level of drop-out from the study and the potential bias of those who did not participate are important limitations to consider.
The implications of this study for clinical practice are clear – there is an urgent need to improve the survival rates of patients with psychosis. The high mortality rates observed in this study underscore the need for further research and interventions aimed at addressing the physical comorbidities and suicidal behavior experienced by individuals with psychosis.
In conclusion, while early intervention for psychosis has shown short-term benefits, its long-term effectiveness remains uncertain. Further research is needed to explore how to prolong the positive short-term outcomes of early intervention and improve the survival rates of individuals with psychosis.
