Early intervention in schizophrenia may improve long-term outcome

A variety of sensitive screening instruments enable early detection (ED) of schizophrenia. All European countries should have easy-to-access ED and early-intervention (EI) services with specialized staff to meet patients’ needs, said Anita Riecher-Rössler, Professor of Psychiatry, University of Basel, Switzerland.

For patients who are identified early with an at-risk mental state (ARMS), a transition to psychosis can be predicted with 80% accuracy. One-third of these patients transition to psychosis, which can – in many cases – be prevented through effective interventions. The other two-thirds need support to manage their symptoms, Professor Riecher-Rössler explained.

Delayed treatment has many costs for the patient, their families and society

Delayed treatment worsens prognosis in schizophrenia

The many costs for patients, families and society resulting from delayed treatment were highlighted by both Professor Riecher-Rössler and David McDaid, Associate Professor, London School of Economics, London. For the patient, the costs include:

• delayed and incomplete remission
•  an increased risk of loss of grey matter and cognitive deterioration
•  a need for more frequent hospitalization, in part due to poor treatment compliance often associated with delayed treatment
•  an increased risk of depression or the abuse of alcohol and recreational drugs
•  a more seriously impaired psychological and social development and reduced quality of life

Families are also significantly impacted by delayed treatment for their loved one with schizophrenia, often resulting in a larger financial and supportive burden due to an increased need for care.  Likewise, societal costs can include increased interaction with the healthcare system (meaning higher costs) and the need for additional social care services.

Investment decisions for EI/ED services need to consider all costs associated with not implementing EI/ED in addition to cost-effectiveness, said Professor McDaid. He cited the National Institute of Mental Health RAISE (Recovery After an Initial Schizophrenia Episode) studies, which showed that coordinated specialty care is cost effective, more effective than treatment-as-usual, and most effective when the patient has a shorter duration of untreated psychosis. (For further discussion of the RAISE program, please see another article here).

Only a few European countries have both ED/EI guidelines and services

Only a few European countries — the UK, Netherlands, Switzerland and Spain — have both ED/EI guidelines and services. Marie Odile Krebs, Professor of Psychiatry, University Paris Descartes, Paris, France, explained that the complex structure of the health care system in France had made it difficult to implement nationwide programs.

Many national guidelines on schizophrenia do not yet include ED/EI

Among 23 Eastern European, Central, Baltic and the Southeast European countries, serving 342 million people, ED/EI implementation is variable, explained Nađa Marić-Bojović, Professor of Psychiatry, University of Belgrade, Serbia. She surveyed colleagues in these countries and found that all had national guidelines on schizophrenia, but only 11 included ED/EI; and only two countries, Latvia and Russia, had a national plan. There was no distinction between developing and developed countries.

In Central and Eastern Europe, ED/EI services are the exception rather than the rule and owe their existence to enthusiastic individuals and organizations rather than to strategic development, said Professor Bojović.

Establishing ED/EI guidelines and services is a high priority throughout Europe

Establishing ED/EI guidelines and services to improve prognosis for patients and lower the support and financial burdens on families and society is a high priority throughout Europe.

But implementation has been hindered by a lack of policy and implementation plans by stakeholders, a lack of coordination between services, and a lack of training and supervision of staff.

Local context, system organization and financing are barriers to implementation of ED/EI services

Professor Riecher-Rössler suggested that information and education campaigns targeting the public, at-risk populations, and healthcare professionals could counter these obstacles.

The focus is now on considering local context, system organization, financing and other factors that either act as barriers or facilitators to implementation. In France, a French taskforce is being launched to organize tool-kits in French and propose adaptations of the ED/EI model for the French mental health organization. France is now ready for a national plan, said Professor Krebs.