Psychotic disorders typically emerge in youth, have a lifetime prevalence of 3%, often lead to frequent hospitalization, and derail functioning in school, career and family. Schizophrenia (prevalence of ~1%) is among the most disabling of all medical diseases (Tandon et al., 2008; PMID 18514488). Psychotic disorders have large personal and societal costs; mental health, comorbid medical and substance abuse services cost 11.5% of overall Medicaid expenditure. Annually about 3 in 10,000 persons experience a first psychotic episode yearly. Thus, with a population of ~6,500,000 people, and roughly 20% between the ages of 16-30, .03% or 390 in this age group in Massachusetts will develop a new psychotic disorder in a given year, or roughly 1/day. There is accumulating evidence that early identification and intervention (EI) can greatly minimize the disability caused by these illnesses and improve lives.
EI can substantially reduce relapse, disability and chronicity. Delays of up to 2 years are seen between the onset of psychosis and initiation of treatment (Perkins et al., 2005; PMID 16199825); such delays are associated with poor outcome (Keshavan et al 2003; PMID14989413) and disengagement from the social world and other socially and biologically maladaptive processes (e.g., weight gain, loss of work or interrupted schooling). Stigma, limited mental health training, and negative attitudes about psychiatric treatment interfere with help seeking and delay appropriate diagnoses. The “duration of untreated psychosis” (DUP) can be reduced by early referral and treatment of youth in the early stages of psychotic illness, and such reductions improve long term outcome (Hegelstad et al., 2012; PMID 22407080).
EI may protect brain development. The brain is more “plastic” (better able to adapt) during adolescence and early adulthood. This period of development is also critical to maturation of cognitive, emotional, and social functioning. The emergence of a psychotic disorder is often associated with decline in brain structure and function, as well as deterioration (or failure of normal growth) of social, academic, and vocational functioning, as well as overall quality of life. The timing of therapeutic intervention may be critical to altering brain, cognitive, and functional outcomes and preventing long-term disability.
EI can save lives. Suicide risk is high in early psychosis. In schizophrenia, nearly 50% of all suicides occur in the first 5 years of illness. Many attempt suicide prior to treatment. Specialized EP treatment programs decrease suicide risk (Addington et al., 2004; PMID 14725592). Substance abuse, psychosis, and mood disorders underlie such risk. The risk of violence, including homicide, in mental illnesses such as schizophrenia is highest for those with no, delayed, or inadequate treatment and comorbid substance use disorders during the initial episode, and might be mitigated with early treatment.