Early and not so early interventions to help people with severe mental disorder

Early intervention services for psychosis delay a transition to psychosis for at-risk mental state individuals, but many of those who do not transition to psychosis develop other psychiatric morbidity. Early intervention services have therefore been broadened to provide more comprehensive transdiagnostic services to support mental, physical and sexual health, and psychosocial function, explained pioneer of these services Professor McGorry at WCP 2021.

Early intervention services

"Subthreshold psychotic symptoms, a family history of psychosis and change in functioning contribute to what has been variously described over the past 25 years as an at-risk mental state, ultra-high risk or clinical high risk, and more recently as Stage 1 psychosis", explained Professor Patrick McGorry, University of Melbourne, Australia.

To prevent or delay a transition to psychosis for at-risk mental state individuals, Professor McGorry and his colleagues conceived and pioneered early intervention services for psychosis in the 1990s.1

Subthreshold psychotic symptoms, a family history of psychosis and change in functioning contribute to at-risk mental state, ultra-high risk or clinical high risk

Their work led to the implementation of similar services in many countries and the formation of the International Early Psychosis Association (IEPA) in 1997, which now has 7000 members from 60 countries.2

Early intervention services delay transition to psychosis

  • A 2013 meta-analysis showed a reduction in risk of about 50% at 12 months and that this might extend up to 4 years after entry into the treatment arm4
  • A 2018 systematic review, meta-analysis and meta-aggression showed that, compared to treatment as usual, early intervention services improved outcomes especially over the first 2 years5
  • A 2020 systematic review and pairwaise network meta-analysis demonstrated a significant reduction in transition to psychosis at 12 and 18 months for early intervention with CBT compared with controls, though in network meta-analyses no treatment approach was significantly more effective than any other at decreasing transition6

"Evaluation of the risk for individuals with clinical high risk transitioning to psychosis in a 2012 meta-analysis was found to be 36% after 3 years,"3 said Professor McGorry. "Transition to psychosis can be delayed by early intervention services as follows":


Moving to a transdiagnostic approach

Many of the two-thirds of clinical high-risk individuals who do not make a transition to psychosis develop persisting subthreshold psychotic symptoms or other forms of psychiatric morbidity.7,8 

To address the high prevalence of other mental disorders, the limitations of current risk identification approaches and the dynamic nature of psychopathology, Professor McGorry and his colleagues have broadened their early intervention services to provide more comprehensive transdiagnostic services.9

"There is much more to do in terms of delivering treatments more effectively and at an earlier stage and to discover new and better treatments", said Professor McGorry," and funding is now being provided to support this, with the goals of improving prediction of transition to psychosis and developing new early intervention treatments."10

Stage 1 psychosis is a highly morbid state


Early intervention services have been broadened to provide more comprehensive transdiagnostic services


WCP: World Congress of Psychiatry

CBT: Cognitive Behavioral Therapy

NMA: Network Meta-analysis


BE-NOTPR-0037, approval date 08/2021

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

  1. Yung A, et al. Schizophrenia Bulletin. 1996;22:283–303.
  2. Available at https://en.wikipedia.org/wiki/International_Early_Psychosis_Association. Accessed 27 July 2021.
  3. Fusar-Poli P, et al. Arch Gen Psychiatry. 2012;69:220–9.
  4. Van den Gaag M, et al. Schizophr Res. 2013;149:56–62.
  5. Correll CU, et al. JAMA Psychiatry. 2018;75:555–65.
  6. Devoe DJ, et al. J Clin Psychiatry. 2020;81:17r12053.
  7. Lin A, et al. Am J Psychiatry. 2015;172:249–58.
  8. Fusar-Poli P, et al. JAMA Psychiatry. 2020;77:755–65.
  9. McGorry PD, et al. World Psychiatry. 2018;17:133–42.
  10. National Institutes of Health. Available at: https://www.nih.gov/news-events/news-releases/nih-public-private-partnership-advance-early-interventions-schizophrenia. Accessed 27 July 2021.
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