Ethics and early intervention in psychosis: keeping up the pace and staying in step

The intense clinical and research interest in early psychosis in recent yea rs has highlighted a range of ethical issues which need to be considered ca refully. Our perspective is based on 16 years of clinical and research expe rience with young people at this phase of illness as well as the research c ontributions of many others. We discuss the ethical dilemmas in relation to the three key foci, which make up the early psychosis paradigm. These are the pre-psychotic or prodromal phase, the period of untreated psychosis and the first psychotic episode and the critical period of recovery, which fol lows this. Most attention is devoted to the pre-psychotic period, however e thical considerations related to research in the other two clinical foci ar e briefly covered as well. Our contention is that the ethical issues are es sentially identical to those arising in early intervention research in main stream medicine. This has been concealed by inconsistency and emotion, whic h has great potential to confuse, politicize and derail rational debate. Th e legacy of the isolation of psychiatry from medicine and consequent prejud ice and stigma in the professional as well as the public mind seems to be f uelling a tendency in some societies to view psychiatric research as qualit atively different from other medical research. Sound clinical research data should be allowed to illuminate the options for potential consumers across all phases of illness. The alternative is research paralysis, which would force clinical practice to expand blindly without an evidence base. (C) 200 1 Elsevier Science B.V. All rights reserved.