Early intervention in psychosis
Encyclopedia
Early intervention in psychosis is a clinical approach to those experiencing symptoms of psychosis
for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services
, especially in the United Kingdom.
This approach centers on the early detection and treatment of early symptoms of psychosis during the formative years of the psychotic condition. The first three to five years are believed by some to be a critical period. The aim is to reduce the usual delays to treatment for those in their first episode of psychosis. The provision of optimal treatments in these early years is thought to prevent relapses and reduce the long term impact of the condition. It is considered a secondary prevention strategy.
The duration of untreated psychosis (DUP) has been shown as an indicator of prognosis
, with a longer DUP associated with more long term disability.
, but with an increased focus on the engagement and treatment of this previously untreated population and the provision of evidence based, optimal interventions for clients in their first episode of psychosis. For example, the use of low-dose antipsychotic
medication is promoted ("start low, go slow"), with a need for monitoring of side effects and an intensive and deliberate period of psycho-education for patients and families that are new to the mental health system. Interventions to prevent a further episodes of psychosis (a "relapse") and strategies that encourage a return to normal vocation and social activity are a priority. There is a concept of phase specific treatment for acute, early recovery and late recovery periods in the first episode of psychosis.
); OPUS (Denmark
); TIPS (Norway
); REDIRECT (Birmingham
); LEO CAT (London
).
Prodrome or "at risk mental state
There are specialist services for those with subclinical symptoms of psychosis or other strong indicators of risk of transition to psychosis. The Pace Clinic in Melbourne, Australia, is considered one of the origins of this strategy, along with the Institute of Psychiatry
based service OASIS in South London, Yale Medical School based clinic, PRIME, The Center of Prevention and Evaluation (COPE) at the Columbia University Medical Center
in New York City, the Recognition and Prevention Program
based at the Zucker Hillside Hospital
in Glen Oaks, New York
, and the NAPLS site based at the Emory University Department of Clinical Psychology in Atlanta, Georgia
. These services are able to reliably identify those at high risk of developing psychosis and are beginning to publish encouraging outcomes from randomised controlled trials that reduce the chances of becoming psychotic, including evidence that psychological therapy and high doses of fish oil
have a role in the prevention of psychosis.
views of psychosis and schizophrenia
have gained acceptance. It subscribes to a "post Kraepelin" concept of schizophrenia, challenging the current assumptions originally promoted by Emil Kraepelin
in the 19th century, that schizophrenia (or dementia praecox
) was a condition with a progressing and deteriorating course. Psychosis is now formulated within a diathesis–stress model, allowing a more hopeful view of prognosis, and expects full recovery for those with early emerging psychotic symptoms. It is more aligned with psychosis as continuum (such as with the concept of schizotypy
) with multiple contributing factors, rather than schizophrenia as simply a neurobiological disease
.
Within this changing view of psychosis and schizophrenia, the model has developed from a divergence of several different ideas, and from a number of sites beginning with the closure of psychiatric institutions
signaling move toward community based care. In 1986, the Northwick Park study discovered an association between delays to treatment and disability, questioning the service provision for those with their first episode of schizophrenia. In the 1990s, evidence began to emerge that cognitive behavioural therapy was an effective treatment for delusion
s and hallucination
s. The next step came with the development of the EPPIC early detection service in Melbourne
, Australia
in 1996 and the prodrome clinic led by Alison Yung. This service was an inspiration to other services, such as the West Midlands
IRIS group, including the consumer non-governmental organisation Rethink
; the TIPS early detection randomised control trial in Norway
; and the Danish OPUS trial. In 2001, the United Kingdom Department of Health
called the development of early psychosis teams "a priority". The International Early Psychosis Association, founded in 1998, issued an international consensus declaration together with the World Health Organisation in 2004. Clinical practice guidelines have been written by consensus.
to reduce the severity of symptoms, improve relapse rates, and decrease the use of inpatient care, in comparison to standard care, at 18 months follow up. These studies also clearly show greater levels of user satisfaction with the service. Although the evidence for an ongoing positive impact has yet to be established, some have noted that the underlying assumptions and lack of evidence for the current late intervention standard service approaches make the rationale early intervention "overwhelming".
The earlier 2006 Cochrane review continues to report a lack of strong research evidence for specific early detection and early intervention programmes, although it does acknowledge the need to intervene earlier for those with psychosis. Since that time, the emerging evidence on treatment outcome for early psychosis is positive.
An Australian historical comparison of direct health costs found a clear economic advantage for an early psychosis approach compared to standard care, at 12 month follow up. Another report, commissioned by Orygen Research Centre in Melbourne, concludes: EI not only costs nearly AU$2000 less per person annually than TAU (treatment as usual) in trial-related costs, it also saves nearly AU$1500 in health system and other financial costs...total saving to society of nearly AU$9000 per patient per year. This does not take into account the potential benefits of EI in reducing suicides and positive impact on vocational outcomes.
has probably made the most significant service reform with their adoption of early psychosis teams, with early psychosis now considered as an integral part of comprehensive community mental health services. The Mental Health Policy Implementation Guide outlines service specifications and forms the basis of a newly developed fidelity tool. There is a requirement for services to reduce the duration of untreated psychosis, as this has been shown to be associated with better long term outcome. The implementation guideline recommends:
(Victoria
, Australia
) since the 1990s.
New Zealand
has operated significant early psychosis teams for more than ten years, following the inclusion of early psychosis in a mental health policy document in 1997. There is a national early psychosis professional group, New Zealand Early Intervention in Psychosis Steering Group, organising training events and producing local resources.
and the OPUS randomised trial in Denmark
.
has extensive coverage across most provinces, including established clinical services and comprehensive academic research in British Columbia
(Vancouver
), Alberta
(EPT in Calgary
), and Ontario
(PEPP, FEPP). In the United States, the Early Assessment and Support Alliance is implementing early psychosis intervention statewide.
n Network of Early Psychosis (ANEP) was held in 2004. There are now established services in Singapore
and Hong Kong
.
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
for the first time. It forms part of a new prevention paradigm for psychiatry and is leading to reform of mental health services
Community mental health service
Community mental health services , also known as Community Mental Health Teams in the United Kingdom, support or treat people with mental disorders in a domiciliary setting, instead of a psychiatric hospital . The array of community mental health services vary depending on the country in which...
, especially in the United Kingdom.
This approach centers on the early detection and treatment of early symptoms of psychosis during the formative years of the psychotic condition. The first three to five years are believed by some to be a critical period. The aim is to reduce the usual delays to treatment for those in their first episode of psychosis. The provision of optimal treatments in these early years is thought to prevent relapses and reduce the long term impact of the condition. It is considered a secondary prevention strategy.
The duration of untreated psychosis (DUP) has been shown as an indicator of prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
, with a longer DUP associated with more long term disability.
Components of the model
There are a number of functional components of the early psychosis model, and they can be structured as different sub-teams within early psychosis services. The emerging pattern of sub-teams are currently:Early psychosis treatment teams
Multiple discipline clinical teams providing an intensive case management approach for the first three to five years. The approach is similar to assertive community treatmentAssertive Community Treatment
Assertive community treatment, or ACT, is an intensive and highly integrated approach for community mental health service delivery. ACT programs serve people whose symptoms of mental illness result in severe functional difficulties that interfere with their ability to achieve personally meaningful...
, but with an increased focus on the engagement and treatment of this previously untreated population and the provision of evidence based, optimal interventions for clients in their first episode of psychosis. For example, the use of low-dose antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medication is promoted ("start low, go slow"), with a need for monitoring of side effects and an intensive and deliberate period of psycho-education for patients and families that are new to the mental health system. Interventions to prevent a further episodes of psychosis (a "relapse") and strategies that encourage a return to normal vocation and social activity are a priority. There is a concept of phase specific treatment for acute, early recovery and late recovery periods in the first episode of psychosis.
Early detection function
Interventions aimed at improving the detection and engagement of those early in the course of their psychotic conditions. Key tasks include being aware of early signs of psychosis and improving pathways into treatment. Teams provide information and education to the general public and assist GPs with recognition and response to those with suspected signs, for example: EPPIC's Youth Access Team (YAT) (MelbourneMelbourne
Melbourne is the capital and most populous city in the state of Victoria, and the second most populous city in Australia. The Melbourne City Centre is the hub of the greater metropolitan area and the Census statistical division—of which "Melbourne" is the common name. As of June 2009, the greater...
); OPUS (Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
); TIPS (Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
); REDIRECT (Birmingham
Birmingham
Birmingham is a city and metropolitan borough in the West Midlands of England. It is the most populous British city outside the capital London, with a population of 1,036,900 , and lies at the heart of the West Midlands conurbation, the second most populous urban area in the United Kingdom with a...
); LEO CAT (London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
).
Prodrome or "at risk mental stateAt risk mental stateAt risk mental state is the term used to describe the clinical presentation of those considered at risk of developing psychosis or schizophrenia...
" clinics
There are specialist services for those with subclinical symptoms of psychosis or other strong indicators of risk of transition to psychosis. The Pace Clinic in Melbourne, Australia, is considered one of the origins of this strategy, along with the Institute of PsychiatryInstitute of Psychiatry
The Institute of Psychiatry is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place...
based service OASIS in South London, Yale Medical School based clinic, PRIME, The Center of Prevention and Evaluation (COPE) at the Columbia University Medical Center
Columbia University Medical Center
Columbia University Medical Center is an academic medical center that includes Columbia University's College of Physicians and Surgeons, College of Dental Medicine, School of Nursing and Mailman School of Public Health...
in New York City, the Recognition and Prevention Program
Recognition and Prevention Program
The Recognition and Prevention Program is a research and specialty clinic located in the Zucker Hillside Hospital in Glen Oaks, New York. It provides education and treatment for young people and their families, and conducts research about the effects of early identification in preventing the...
based at the Zucker Hillside Hospital
Zucker hillside hospital
The Zucker Hillside Hospital, previously known as Hillside Hospital, is an in-patient and out-patient psychiatric hospital and clinic in the borough of Queens in New York City. In 1999 Donald and Barbara Zucker contributed a substantial amount of money to Hillside Hospital and the name of the...
in Glen Oaks, New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, and the NAPLS site based at the Emory University Department of Clinical Psychology in Atlanta, Georgia
Georgia (U.S. state)
Georgia is a state located in the southeastern United States. It was established in 1732, the last of the original Thirteen Colonies. The state is named after King George II of Great Britain. Georgia was the fourth state to ratify the United States Constitution, on January 2, 1788...
. These services are able to reliably identify those at high risk of developing psychosis and are beginning to publish encouraging outcomes from randomised controlled trials that reduce the chances of becoming psychotic, including evidence that psychological therapy and high doses of fish oil
Fish oil
Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid , and docosahexaenoic acid , precursors of certain eicosanoids that are known to reduce inflammation throughout the body, and are thought to have many health benefits.Fish do not...
have a role in the prevention of psychosis.
History
Early intervention in psychosis is a preventative approach for psychosis that has evolved as contemporary recoveryRecovery model
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
views of psychosis and schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
have gained acceptance. It subscribes to a "post Kraepelin" concept of schizophrenia, challenging the current assumptions originally promoted by Emil Kraepelin
Emil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
in the 19th century, that schizophrenia (or dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
) was a condition with a progressing and deteriorating course. Psychosis is now formulated within a diathesis–stress model, allowing a more hopeful view of prognosis, and expects full recovery for those with early emerging psychotic symptoms. It is more aligned with psychosis as continuum (such as with the concept of schizotypy
Schizotypy
Schizotypy is a psychological concept which describes a continuum of personality characteristics and experiences ranging from normal dissociative, imaginative states to more extreme states related to psychosis and in particular, schizophrenia...
) with multiple contributing factors, rather than schizophrenia as simply a neurobiological disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
.
Within this changing view of psychosis and schizophrenia, the model has developed from a divergence of several different ideas, and from a number of sites beginning with the closure of psychiatric institutions
Deinstitutionalisation
Deinstitutionalization or deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less isolated community mental health service for those diagnosed with a mental disorder or developmental disability. Deinstitutionalization can have multiple definitions; the first...
signaling move toward community based care. In 1986, the Northwick Park study discovered an association between delays to treatment and disability, questioning the service provision for those with their first episode of schizophrenia. In the 1990s, evidence began to emerge that cognitive behavioural therapy was an effective treatment for delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s and hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s. The next step came with the development of the EPPIC early detection service in Melbourne
Melbourne
Melbourne is the capital and most populous city in the state of Victoria, and the second most populous city in Australia. The Melbourne City Centre is the hub of the greater metropolitan area and the Census statistical division—of which "Melbourne" is the common name. As of June 2009, the greater...
, Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
in 1996 and the prodrome clinic led by Alison Yung. This service was an inspiration to other services, such as the West Midlands
West Midlands (region)
The West Midlands is an official region of England, covering the western half of the area traditionally known as the Midlands. It contains the second most populous British city, Birmingham, and the larger West Midlands conurbation, which includes the city of Wolverhampton and large towns of Dudley,...
IRIS group, including the consumer non-governmental organisation Rethink
Rethink
Rethink Mental Illness is a charity in England. Its mission statement is "Working together to help everyone affected by severe mental illness recover a better quality of life." The organisation was founded in 1972 by relatives of people diagnosed with schizophrenia, following an article by a...
; the TIPS early detection randomised control trial in Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
; and the Danish OPUS trial. In 2001, the United Kingdom Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
called the development of early psychosis teams "a priority". The International Early Psychosis Association, founded in 1998, issued an international consensus declaration together with the World Health Organisation in 2004. Clinical practice guidelines have been written by consensus.
Clinical outcome evidence
An early psychosis approach has been shown in formal studiesRandomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
to reduce the severity of symptoms, improve relapse rates, and decrease the use of inpatient care, in comparison to standard care, at 18 months follow up. These studies also clearly show greater levels of user satisfaction with the service. Although the evidence for an ongoing positive impact has yet to be established, some have noted that the underlying assumptions and lack of evidence for the current late intervention standard service approaches make the rationale early intervention "overwhelming".
The earlier 2006 Cochrane review continues to report a lack of strong research evidence for specific early detection and early intervention programmes, although it does acknowledge the need to intervene earlier for those with psychosis. Since that time, the emerging evidence on treatment outcome for early psychosis is positive.
Current literature on cost
Evidence from the United Kingdom suggests that the costs of an early psychosis service are considerably less compared to standard care with one year costs for early psychosis teams (£9,422) two thirds the cost of standard teams (£14,394). This is maintained at Year 3 and is thought to be due to the reduced inpatient costs with the more intensive community follow up provided by early psychosis services.An Australian historical comparison of direct health costs found a clear economic advantage for an early psychosis approach compared to standard care, at 12 month follow up. Another report, commissioned by Orygen Research Centre in Melbourne, concludes: EI not only costs nearly AU$2000 less per person annually than TAU (treatment as usual) in trial-related costs, it also saves nearly AU$1500 in health system and other financial costs...total saving to society of nearly AU$9000 per patient per year. This does not take into account the potential benefits of EI in reducing suicides and positive impact on vocational outcomes.
United Kingdom
The United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
has probably made the most significant service reform with their adoption of early psychosis teams, with early psychosis now considered as an integral part of comprehensive community mental health services. The Mental Health Policy Implementation Guide outlines service specifications and forms the basis of a newly developed fidelity tool. There is a requirement for services to reduce the duration of untreated psychosis, as this has been shown to be associated with better long term outcome. The implementation guideline recommends:
- 14 to 35 year age entry criteria
- First three years of psychotic illness
- Aim to reduce the duration of untreated psychosis to less than 3 months
- Maximum caseload ratio of 1 care coordinator to 10–15 clients
- For every 250,000 (depending on population characteristics), one team
- Total caseload 120 to 150
- 1.5 doctors per team
- Other specialist staff to provide specific evidence based interventions
Australia and New Zealand
Services have spread from the origin founding EPPIC initiative in MelbourneMelbourne
Melbourne is the capital and most populous city in the state of Victoria, and the second most populous city in Australia. The Melbourne City Centre is the hub of the greater metropolitan area and the Census statistical division—of which "Melbourne" is the common name. As of June 2009, the greater...
(Victoria
Victoria (Australia)
Victoria is the second most populous state in Australia. Geographically the smallest mainland state, Victoria is bordered by New South Wales, South Australia, and Tasmania on Boundary Islet to the north, west and south respectively....
, Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
) since the 1990s.
New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
has operated significant early psychosis teams for more than ten years, following the inclusion of early psychosis in a mental health policy document in 1997. There is a national early psychosis professional group, New Zealand Early Intervention in Psychosis Steering Group, organising training events and producing local resources.
Scandinavia
Early psychosis programmes have continued to develop from the original TIPS services in NorwayNorway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
and the OPUS randomised trial in Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
.
North America
CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
has extensive coverage across most provinces, including established clinical services and comprehensive academic research in British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
(Vancouver
Vancouver
Vancouver is a coastal seaport city on the mainland of British Columbia, Canada. It is the hub of Greater Vancouver, which, with over 2.3 million residents, is the third most populous metropolitan area in the country,...
), Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
(EPT in Calgary
Calgary
Calgary is a city in the Province of Alberta, Canada. It is located in the south of the province, in an area of foothills and prairie, approximately east of the front ranges of the Canadian Rockies...
), and Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
(PEPP, FEPP). In the United States, the Early Assessment and Support Alliance is implementing early psychosis intervention statewide.
Asia
The first meeting of the AsiaAsia
Asia is the world's largest and most populous continent, located primarily in the eastern and northern hemispheres. It covers 8.7% of the Earth's total surface area and with approximately 3.879 billion people, it hosts 60% of the world's current human population...
n Network of Early Psychosis (ANEP) was held in 2004. There are now established services in Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...
and Hong Kong
Hong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
.
See also
- SchizophreniaSchizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
- Recovery modelRecovery modelThe Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
- DeinstitutionalisationDeinstitutionalisationDeinstitutionalization or deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less isolated community mental health service for those diagnosed with a mental disorder or developmental disability. Deinstitutionalization can have multiple definitions; the first...
External links
- Early Psychosis Prevention and Intervention Centre (EPPIC)
- Rethink: What is Early Intervention
- Initiative to Reduce Impact of Schizophrenia (IRIS)
- Psychosis sucks, British Columbia, Canada
- TIPS, Stavanger, Norway
- The Recognition and Prevention Program (RAP), Glen Oaks, NY, USA