THE FEASIBILITY AND EFFECTIVENESS OF EARLY INTERVENTION IN PSYCHOTIC DISORDERS - THE AUSTRALIAN EXPERIENCE

In an attempt to provide optimum treatment for young people with emerg ent psychosis, we have developed the Early Psychosis Prevention and In tervention Centre (EPPIC), which is designed to identify young patient s in the early stages of first-episode psychosis and provide them with a comprehensive, sustained community-based service intended to minimi ze primary and secondary morbidity. Key elements of EPPIC are the mobi le Early Psychosis Assessment Team, minimal inpatient treatment, conti nuity of care, a day program for recovering patients, specialist famil y work, and cognitively oriented psychotherapy for early psychosis. Pr eliminary evaluation of this model against our previous intensive inpa tient program, comparing 51 EPPIC patients treated in March-October 19 93 with 51 pre-EPPIC historical controls (1989-1992) matched for key v ariables, indicates that the EPPIC model is associated with shorter du rations of untreated psychosis, reduced inpatient treatment, reduced n euroleptic use without deterioration in Brief Psychiatric Rating Scale scores, improvements in negative symptoms and better psychosocial fun ctioning. The EPPIC program is cheaper and more cost-effective than th e pre-EPPIC system, even within a 12-month follow-up period. Early int ervention with an approach tailored to the specific needs of young fir st-episode patients is feasible and effective. Future research should focus on optimizing pharmacotherapy and integrating this with speciali st psychological treatments, early identification of treatment-resista nt patients and, ultimately, prepsychotic identification and intervent ion. (C) 1998 Rapid Science Ltd.