Early Intervention Works, But U.S. Lags Behind Some Other Countries


“We have so much catching up to do when it comes to early intervention for psychosis,” said Stephen Adelsheim, M.D., a professor of psychiatry at Stanford University, in a symposium today at APA’s 2016 Annual Meeting titled “Community-Based Programs for Early Intervention in Psychosis.”

Adelsheim; Lisa Dixon, M.D., M.P.H., a professor of psychiatry at Columbia University; and Kenneth Duckworth, M.D., executive director of the National Alliance for the Mentally Ill, gave a broad overview of early intervention programs in Maine, New Mexico, New York, and elsewhere in the United States and described a robust and growing evidence base for the effectiveness of early intervention. But Adelsheim noted that prevention and early intervention are far more entrenched in Europe and Australia. “We have a long way to go in the United States,” he said.

Adelsheim described his own work on developing and implementing early detection/intervention programs for young people in school-based and primary care settings, including programs for depression, anxiety, prodromal symptoms of psychosis, and first episodes of psychosis.

He presented data from the NIMH RAISE (Recovery After an Initial Schizophrenia Episode) Early Treatment Program showing that 404 individuals enrolled in the program had had a median of 74 weeks of untreated psychosis. And 68 percent had a duration of untreated psychosis (DUP) greater than six months.

“Shorter DUP is associated with better response to antipsychotics, greater decrease in both positive and negative symptom severity, decreased frequency of relapse, more time at school or work, and overall improved treatment response over time,” he said.

Adelsheim emphasized the importance of outreach to communities in making early intervention successful and described strategies targeting schools and school-based providers to provide information about psychosis. These include focused training efforts for school counselors and nurses about early warning signs, student and parent educational efforts, and ongoing management of stigma.

“Generally programs have begun to see referrals for adolescents who may display early warning signs within one to two months after community presentations,” Adelsheim said.

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