Open dialogue in psychosis II: A comparison of good and poor outcome cases

As an approach to treatment of psychosis, Open Dialogue aims to begin treat ment within 24 hours of first contact between the health system and the pat ient or family, and in accordance with social constructionist principles, i t includes the family and the social network in open discussion of all issu es throughout treatment. As one step toward evaluating the impact of this n ovel model of care, statistical and qualitative analyses of 78 consecutive first-episode psychotic cases was undertaken, discriminating good from poor outcome cases on the basis of functional and symptomatic criteria. Results suggested differences in the diagnosis and duration of prodromal and psych otic symptoms, as well as in treatment processes in the two groups. Avoidin g hospitalization and using anxiolytics instead of neuroleptics were associ ated with a good outcome. Overall, data bearing on the effectiveness of OD were encouraging, as only 22% poor outcome patients emerged. However, if th e possibility for starting a dialogical process is minimal, the treatment m ay lead to poor outcome, even where this is not predicted by premorbid soci al and psychological factors.