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Review finds limited evidence for early intervention in psychosis

Early intervention mental health policies may be gaining favour in Australia, Europe and the U.S. but there is limited evidence…

More studies are needed to conclude that early treatment provides long term benefits for sufferers of psychosis, a major literature review has found. Flickr/Arturo Sotillo
Early intervention mental health policies may be gaining favour in Australia, Europe and the U.S. but there is limited evidence to show they help sufferers of psychosis in the longer term, a major literature review has found.

The Australian government set aside $222.4 million over five years in the last federal budget for 16 Early Psychosis Prevention and Intervention Centres (EPPIC) to treat young people who have experienced psychotic episodes, following campaigns by youth mental health advocates such as 2010 Australian of the Year, Patrick McGorry from the Orygen Youth Health research centre.

However, a literature review by the Cochrane Collaboration – an international not-for-profit group of health care academics, professionals and policy makers – has found that of the 18 early intervention studies reviewed, none had produced definitive evidence the technique led to long term gains.

“Early intervention services are now widespread in America, Europe and Australia.

We sought to review all trials that involved early intervention for people with prodromal (early stage) symptoms, or a first episode of psychosis,“ the report said.

“We identified 18 studies, most were underpowered and at present we have insufficient data to draw any definitive conclusions, although further trials are expected.”

The report said there was emerging but inconclusive evidence that people in the early stages of psychosis could be helped by certain interventions but that “further trials would be desirable, and there is a question of whether gains are maintained.”

“There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.”

Professor Anthony Jorm from Orygen Youth Health Research Centre and the University of Melbourne said the review showed that short-term interventions may be ineffective.

“The message that I take from the Cochrane Review is that any time-limited approach may only have a time-limited effect,” he said.

“I think we need to take more of a lifespan approach to helping people with mental illnesses rather than focus on recovery from a first episode or a current episode. While people tend to recover from mental illnesses, relapse is common.”

“We need to invest efforts into preparing the person, their family and other supporters to manage in the longer-term. Support needs to be ongoing to have long-term benefits.”

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  1. Melissa Raven

    Adjunct lecturer at Flinders University

    Notably, the main EPPIC study was excluded from the Cochrane review, because it was methodologically weak – it was a non-randomised before-and-after study with historical trials (p. 81, listed as 'McGorry 1996'). This is the second worst level of evidence according to the National Health and Medical Research Council: 'III-3 evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group' (NHMRC 1999, p…

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  2. Anupriya Wijayaweera


    Furthermore, Professor Alan Francis, noted Professor of psychiatry and author of DSM IV has said that misdiagnoses rates could be as high as 90%.
    Iam not quite sure what exactly is wrong with our politicians to approve such a monstrosity, listening only to those with biased and self interested connections. This is in sync with the ignorance inherent in the act of climate change denial. One is over enthusiasm about unscientific bad research methodology and the other is not taking properly researched scientific data seriously.

    1. Melissa Raven

      Adjunct lecturer at Flinders University

      In reply to Anupriya Wijayaweera

      Good points Anupriya.
      The Cochrane review makes this point about vested interests:
      'many of the trials were undertaken by leading figures in the world of early intervention who could have a vested interest in the findings – just as industry has in the outcomes for the drugs they manufacture.' (Marshall & Rathbone 2011, p. 24)

  3. Melissa Raven

    Adjunct lecturer at Flinders University

    Allen Frances is indeed a strong critic of early psychosis intervention, for many reasons, including very high false positive rates. He has published a series of articles/blogs on Psychology Today and Psychiatric Times, including:
    'Continuing Controversy On Australia's Mental Health Experiment: Seven questions for Dr McGorry'
    'Prophet of Preventive Psychiatry Recants'

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    1. Anupriya Wijayaweera


      In reply to Melissa Raven

      You may want to review this disturbing report by 7 News about Professor Graham Burrows, over medication, misdiagnoses and the antipsychotic drugs risperdal, zyprexa and seroquel.(Professor Burrows was the psychiatrist that said that the man who threw his daughter off the bridge was psychotic.) It is time our politicians woke up and stopped writing carte blanche cheques to the psychiatric drug industry.
      This is also on CCHR