A Canadian programme for early intervention in non-affective psychotic disorders

Authors

  • Ashok Malla,

    Corresponding author
      Ashok Malla, Professor (Correspondence)
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  • Ross Norman,

    1. Ashok Malla, Professor (Correspondence); Terry McLean, Clinical ­Specialist
      Division of Clinical Research, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Boul, Verdun, Québec, Canada, H4H 1R3. Email: ashok.malla@douglas.mcgill.ca

      Ross Norman, Professor
      Department of Psychiatry, University of Western Ontario, London, ­Ontario, Canada

      Derek J Scholten, Research Associate; Laurel Townsend, Clinical ­Psychologist
      London Health Sciences Centre, London, Ontario, Canada
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  • Terry McLean,

    1. Ashok Malla, Professor (Correspondence); Terry McLean, Clinical ­Specialist
      Division of Clinical Research, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Boul, Verdun, Québec, Canada, H4H 1R3. Email: ashok.malla@douglas.mcgill.ca

      Ross Norman, Professor
      Department of Psychiatry, University of Western Ontario, London, ­Ontario, Canada

      Derek J Scholten, Research Associate; Laurel Townsend, Clinical ­Psychologist
      London Health Sciences Centre, London, Ontario, Canada
    Search for more papers by this author
  • Derek Scholten,

    1. Ashok Malla, Professor (Correspondence); Terry McLean, Clinical ­Specialist
      Division of Clinical Research, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Boul, Verdun, Québec, Canada, H4H 1R3. Email: ashok.malla@douglas.mcgill.ca

      Ross Norman, Professor
      Department of Psychiatry, University of Western Ontario, London, ­Ontario, Canada

      Derek J Scholten, Research Associate; Laurel Townsend, Clinical ­Psychologist
      London Health Sciences Centre, London, Ontario, Canada
    Search for more papers by this author
  • Laurel Townsend

    1. Ashok Malla, Professor (Correspondence); Terry McLean, Clinical ­Specialist
      Division of Clinical Research, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Boul, Verdun, Québec, Canada, H4H 1R3. Email: ashok.malla@douglas.mcgill.ca

      Ross Norman, Professor
      Department of Psychiatry, University of Western Ontario, London, ­Ontario, Canada

      Derek J Scholten, Research Associate; Laurel Townsend, Clinical ­Psychologist
      London Health Sciences Centre, London, Ontario, Canada
    Search for more papers by this author

Ashok Malla, Professor (Correspondence)

Abstract

Objectives: To provide a brief overview of the development of clinical services and research for early intervention in psychotic disorders in Canada; to describe components of a comprehensive clinical/research programme for nonaffective psychotic disorders; and to present a summary of results of clinical and social outcomes achieved.

Method: This is a descriptive paper providing some details of how clinical services are being developed in Canada and concentrating on one particular early intervention programme, Prevention and Early intervention Programme for Psychoses (PEPP) London, Ontario, which is using a historical control design to evaluate the impact of an assertive approach to community case detection. Components of a phase-specific treatment programme and early case detection are described followed by results based on clinical and psychosocial data collected according to a defined protocol.

Results: One year outcome for patients treated in PEPP shows use of low dose, pre­dominantly novel antipsychotics and high (81.5%) retention and remission (75%) rates. Highly significant improvements were also reported for self-rated quality of life and cognition. Duration of untreated psychosis (DUP) and premorbid adjustment were associated with improvement in positive and negative symptoms, respectively. Systemic changes to improve access to the service resulted in substantial increases in number of cases treated and a> 50% decline in DUP.

Conclusions: Phase-specific treatment approach and case identification strategies to reduce delay in treatment are likely to substantially improve outcome in nonaffective psychotic disorders compared with what has been reported with traditional approaches.

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