International clinical practice guidelines for early psychosis

INTERNATIONAL EARLY PSYCHOSIS ASSOCIATION WRITING GROUP1

Correspondence: Professor Patrick McGorry, MD, PhD, FRCP, FRANZCP, Department of Psychiatry, University of Melbourne and ORYGEN Research Centre, Locked Bag 10/35, Poplar Road, Parkville, Victoria 3052, Australia.

1 The following international consultants contributed to the drafting of these guidelines which was endorsed at the third International Early Psychosis Conference, Copenhagen, September 2002:

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   ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 
These international clinical practice guidelines were developed with detailed input from 29 invited international consultants, who provided content as well as detailed feedback on draft versions.The final draft of the guidelines was ratified by the Executive of the International Early Psychosis Association and presented and formally endorsed at the Third International Conference on Early Psychosis held in Copenhagen, September 2002. They have been revised slightly to include medications that were not available in 2002, although a fully comprehensive process of update has not yet been conducted.The final version is published in this Supplement with the aim of encouraging further discussion as well as providing practical guidance to clinicians and researchers. A second edition is planned for publication in 2008.


   INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 
The delivery of care in early psychosis is often delayed, piecemeal and alienating to patients and families. Patients usually have to cross a high threshold of disturbance and risk to gain access to treatment, and have to demonstrate a persistent and pervasive level of disability (or activity limitation/participation restriction) to ‘earn’ the right to continuing care. Treatment models are geared to the needs of older patients with chronic conditions, reinforcing the pessimism inherent in the concept of schizophrenia. Community ignorance, stigma (operating in the larger community and within mental health services), poor mental health literacy, and the isolation of psychiatry from the rest of medicine and healthcare add to the obstacles to reforming systems to focus on early intervention. A special focus on the early phases of psychotic disorders is justified on three major grounds:

There are three targets for preventive interventions in early psychosis:

This draft consensus statement identifies key principles in addressing current deficiencies for preventive intervention and proposes strategies to enhance clinical care. The statement has been developed with input from the 29 invited international consultants who gave feedback by the publication deadline. The guidelines were presented and ratified at the Third International Conference on Early Psychosis held in Copenhagen in September 2002.


   GENERAL STATEMENTS
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 


   PREPSYCHOTIC PERIOD
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 
Background
The prepsychotic period can be divided into two phases:

Clinical guidelines

Research


   FIRST EPISODE OF PSYCHOSIS
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 
Clinical guidelines: access

Clinical guidelines: location of treatment

Clinical guidelines: initial management


   RECOVERY (6–18 MONTHS) AND THE CRITICAL PERIOD (UP TO 5 YEARS)
 TOP
 ABSTRACT
 INTRODUCTION
 GENERAL STATEMENTS
 PREPSYCHOTIC PERIOD
 FIRST EPISODE OF PSYCHOSIS
 RECOVERY (6-18 MONTHS) AND...
 
The time periods of 6–18 months for ‘recovery’ and up to 5 years as the ‘critical period’ are speculative. Time for remission of symptoms and risk of recurrence is highly variable and largely unknown.

Background

Clinical guidelines





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