Book Review
General Psychiatry
Implementing Early Intervention in Psychosis: A Guide to Establishing Early Psychosis Services. Jane Edwards, Patrick D McGorry. London (UK): Martin Dunitz Ltd; 2002. 186 p. CAN $44.75.
Reviewer
rating*: Excellent
Review by: George Voineskos, MD
Toronto, Ontario
This splendid book contributes to the enormous interest that has developed over the past 10 years in first episode psychosis and early intervention services. It is meant to be used as a source of important information: the erudite, concise description of several early psychosis services in different countries and the provision of Web sites, e-mail contacts, and a large number of references fulfill its stated purpose.
The authors have gained a wealth of experience directing the Early Psychosis Prevention and Intervention Center (EPPIC) at the Department of Psychiatry, University of Melbourne. This centre was started in 1984 as an inpatient service and gradually evolved into an excellent paradigm of service for first episode psychosis.
In the 1990s, several services for early psychosis—usually for patients between the ages of 12 to 14 years and 25 to 29 years—were started in Canada, the US, Europe, and South Africa. Recently, planning for such services has taken place in the Far East. In England, the Department of Health has since 2001 required that early intervention services, established according to specified guidelines, be available across the country. The prevailing view is that early detection and treatment of psychosis in young people will increase engagement, improve outcome, and reduce deficits in social functioning that set a “ceiling” for recovery.
The book has 9 chapters and 3 appendices. Chapter 1 summarizes the benefits of early detection of new cases, of early intervention, and of providing optimal and sustained treatment during the highly vulnerable “critical period” following recovery, which can extend for up to 5 subsequent years. Chapters 2 to 4 detail key service elements, including early recognition, initial assessment and treatment, and promotion of recovery. In these chapters, the authors draw on their experience with EPPIC to emphasize the pivotal role of effective engagement; of the first experience with medication; of treatment at home, if resources permit it, or of minimizing negative impact on the individual, if hospitalization is required; and of psychoeducation and cognitive therapy. Subsequent outpatient case management, family work, social treatment, and vocational rehabilitation are detailed. Chapter 5 describes 5 different models of early psychosis services, starting with EPPIC. The other 4 services were developed in the mid-1990s and comprise a service in Norway and Denmark, a service in Birmingham and in West Midlands, UK; and 2 services in Canada, namely, the Early Psychosis Program (EPP) in Calgary and the Prevention and Early Intervention Program for Psychosis (PEPP) in London, Ontario, both of which began in 1996.
Chapters 6 to 9 constitute the second half of the book and deal with strategies for an early psychosis service development, a process that may take 2 to 3 years, according to the authors. Chapter 6 describes a 9-step model for service development and includes examples from several services. Chapter 7 deals with evaluation, which is essential to service survival. Chapter 8 discusses the advantages and disadvantages of the specialist vs the generalist service model. The First Episode Psychosis Program at the Centre for Addiction and Mental Health at the University of Toronto, developed in 1992, is described as an example of an integrated inpatient–outpatient program. The chapter ends with organizational and professional development issues. Chapter 9 contains a consensus statement on the principles and practice of treating first- episode psychosis. Appendix 1 contains useful psychoeducation resource material for early psychosis. Appendix 2 summarizes the Australian best-practice clinical guidelines for first onset psychosis. Appendix 3 outlines the European First Episode Schizophrenia Network consensus on optimum first episode care.
The authors have done a commendable job in this book and have explained the rationale of early psychosis services for young people admirably well, while calling for ongoing evaluation. However, controversy has already reached professional publications in the UK, based on the premise that services for early psychosis either drain resources away from traditional services or lack staff with the required specialized intervention skills (1,2). Nevertheless the notion of offering specialized services to the young who may suffer from psychosis is irresistible.
The book is concise, clear, and easy to read. Its layout is attractive, with boxes in pink highlighting descriptions or other important points. The production is free from errors, and the price is reasonable. I highly recommend this book to all those working in, or interested in, the mental health field.
References
1. Holloway F, Aitchison K. Early intervention in psychosis: from government prescription to clinical practice. Psychiatr Bull 2003;27:243–4.
2. Pelosi AJ, Birchwood M. Is early intervention a waste of valuable resources? Br J Psychiatry 2003;182:196–8.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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