Early Intervention For Psychosis Programs Arrive Too Late, Don’t Address Childhood Adversity

Rob Wipond
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Early intervention in psychosis (EIP) efforts have not delivered on their promise of preventing more serious schizophrenia from developing, according to a review of the literature published in Progress in Neurology and Psychiatry. And the problem may be, the authors argued, that EIP efforts actually still come too late while attempting to address the wrong causes.

Writing with a medical student, University of Hull psychiatrist Ann Mortimer stated that EIP programs have essentially been founded on what may be a false assumption. Just because a lot of young people with serious, problematic schizophrenia symptoms often don’t get treatment early, they wrote, doesn’t necessarily mean that if they are treated early, their outcomes will be better.

“The finding that longer duration of untreated psychosis (DUP) was associated with poor premorbid functioning in the year before onset, insidious onset and more negative symptoms at onset, then led to the widely accepted, but rather sweeping assumption, that by reducing the duration of untreated psychosis, longterm outcome could be improved,” they wrote. “The obvious alternative, however, is that schizophrenia of the kind which leads to a poor outcome is naturally associated with insidious onset, worsening premorbid function and a lack of help seeking. Thus, lengthy duration of untreated psychosis is integral to poor outcome. Early treatment will not make a difference, because poor outcome is predetermined by intrinsic severity factors that command poor treatment responsiveness, whenever treatment starts.”

In their review of the scientific literature, they highlighted many studies that found no improvements among groups that received early intervention. They also described over-arching problems in those studies that seemed to find positive outcomes. For example, one study, they wrote, had a strong bias: When people dropped out of the early detection group, that was described as a positive outcome because it was assumed the people no longer needed treatment; however, when participants dropped out of the other group, it was considered to be a sign that their psychotic conditions were worsening. In another study, the majority of patients were engaged in “extensive substance abuse, usually cannabis, stimulants or both,” and hence their symptoms may have been substance-induced psychosis rather than schizophrenia per se, suggested the authors.

The authors also suggested that some apparent positive outcomes are actually being caused by the fact that EIP tends to “bycatch” many young people who aren’t and won’t ever become psychotic, anyway. The authors described it as an “inescapable” issue of concern that commonly assumed schizophrenia inception rates are about 7-14 per 100,000 population per year, while referral rates to EIP services are typically around 100 per 100,000 per year. “Just what is going on here?” they asked.

They also noted the high rates of childhood trauma and other types of adversity common among young people being drawn into EIP efforts, and argued that EIP may be a misplaced, belated misuse of resources and efforts. “Nevertheless, childhood adversity and its causes are social problems, which rationally require social solutions, not young people’s mental health services post hoc. Ensuring that every child is adequately parented, securely integrated within their family, and benefits from caring educational provision and supportive workplaces, is an ideal that perhaps should not be compromised by the enormous task of its realisation. Early intervention can only be expected to work if it addresses treatable disease, as in the rest of medicine.”

Mortimer, Ann, and Timothy Brown. “Early Intervention in Psychosis: Another Triumph of Hope over Experience?” Progress in Neurology and Psychiatry 19, no. 3 (May 1, 2015): 10–14. doi:10.1002/pnp.379. (Abstract) (Full text)

17 COMMENTS

  1. “Nevertheless, childhood adversity and its causes are social problems, which rationally require social solutions, not young people’s mental health services post hoc.” This is very true.

    But unfortunately today, the number one trait of all ‘schizophrenics’ is ACEs or child abuse, wrongly diagnosed as ‘psychosis,’ according to John Read’s research.

    And when the psychiatric industry gives neuroleptics to victims of crimes, rather than people who actually have a brain disease, of course they should expect bad reactions to these toxic torture drugs. And that is what the medical evidence is showing.

    This is likely because the neuroleptic drugs are known to cause both the positive and negative ‘schizophrenia’ symptoms, but the psychiatric industry, in general, is in denial of this reality. Below is the medical proof that the neuroleptics cause both the positive and negative symptoms of ‘schizophrenia.’

    “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    “Neuroleptic induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia—emotional blunting, apathy, hypobulia, difficulty in thinking, difficulty or total inability in concentrating, attention deficits, and desocialization. This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to ‘improve’ what he perceives to be negative symptoms of schizophrenia, rather than antipsychotic side effects.”

    I’d very much like to see the psychiatric industry get out of the business of profiting off turing child abuse victims into ‘schizophrenics’ with their neuroleptics. And, according to the medical evidence, this does seem to be the number one etiology of ‘schizophrenia’ in our society today.

    “Early intervention can only be expected to work if it addresses treatable disease, as in the rest of medicine.” This country needs to start arresting the child molesters again, rather than just cover up child abuse, by turning the victims of child abuse into ‘schizophrenics’ with the neuroleptic drugs.

    The child molesters are aware of the fact that the psychiatric industry has been in the business of covering up child abuse for the religions for decades, this was confessed to me to be the “dirty little secret of the two original educated professions” by an ethical pastor. I’d like to see an end to this “dirty little secret,” paternalistic, societal problem.

    • People who are in power are all about consolidation of power, always to the detriment of the powerless. This is how they make further gains in power. Since power is intoxicating and addictive, many may not even understand that they are doing this, or if a glimmer of conscience pops into their heads, they quickly suppress it to stay along their linear objective that gains them more power. I have had it done to me and my children – the social service agencies discounting and discrediting me in favor of my abusive, pedophilic, alcoholic husband, to the detriment of myself and my children

  2. Maybe the problem is that most Early Intervention Programs suck. They are neither intensive nor lengthy enough to help psychotic youth, nor provided by treaters who are well educated in how to understand and transform psychotic distress outside of the medical model.

    When you read about these programs, they often involve medication (a bad long-term factor), a medical model of viewing “the illness” (another bad factor), plus a limited amount of psychotherapy/family therapy/job support. Often these social supports are offered once a week, bi-weekly, or even less for only one or two years. That just isn’t enough for most people labeled “schizophrenic”!

    Psychotic individuals, who are often dealing with massive ego deficits and who need to experience a secure long-term symbiotic relationship with a trusted parent figure to gain the psychological security to function and relate better, benefit much more from 2-4x weekly individual or group psychotherapy offered for 3-5 years or more. This process is described by authors like Benedetti, Sandin, Volkan, Steinman, Lotterman, and many others writing at http://www.ISPS.org . In fact, many of these authors treat people who have already been psychotic for years – i.e. who would be considered to have a long DUP and a poor prognosis in these studies – but many of these people nevertheless recover and become able to function well with intensive-enough support .

    This gives the lie to Mortimer’s idea that “”because poor outcome is predetermined by intrinsic severity factors that command poor treatment responsiveness, whenever treatment starts.” What a bunch of BS that is, most likely written by someone who has never understood or helped psychotic individuals in depth psychotherapy. Outcome is not predetermined.

    It’s no surprise then that these meagre, inadequte 1 or 2 year treatments labeled “early intervention” don’t make much of a lasting difference. They are kind of like trying to treat pneumonia with a cold medicine that lasts only a few hours.

    On the other hand, it should be noted that Mortimer’s study did not include the Open Dialogue results, nor did it include the recent RAISE results recently reported by Dixon et al. I encourage readers to check these out.

    • bpd – I think they realize that they have an ad hoc argument in hand, so they are intentionally aiming not to highlight the things you suggest. What that is not nefarious, but only arises from misconception, would motivate them to throw their winnowing out of casework by example idea into the mix? Desire for publication and knowing you can’t publish anything great, since your theories haven’t shown definitive results, isn’t an adequate excuse in the helping professions for staking the claim to your turf, either. But I would suppose that they could only be meaning and hoping to also gear something back having to do with external criticism by juggling some appearances and changing up the pitches and smart talk overlays, and then add to that good work with the intention to suggest stimulating new empirical results by changing the population arrested for behavioral healthcare’s scientific purposes. Meanwhile, you surely thought of all this, and still more understanding was behind your reply, no doubt, as indicated by your reading and the link you enabled. I only want to add that having schizophrenia as the golden ring of all that psychiatry means to neuroscience and psychiatry’s own public relations efforts, for brandishing selectively in reaction to changing purposes, particularly whenever the chips are down, keeps it as an insitution safe from lethal or decimating harm in its coercive formulation, as long as the Academy and the press like things that most the way it needs and likes things, too. We are just waiting around if we aren’t focussing on movement principles almost verbatim as laid out in the Szaszian critique and alternative human rights approaches very like it. It gets hard for most people to see what gives the lie to every little justification for intervention as suits the beast we are fighting, and fighting with it to get fixed up nice isn’t going to make the press less lazy or higher education more socially determined about trying do what’s right for us all. We will just see more people there than ever getting along with each other, and praising the kind of opportunity freedom gave them, and damning the poor communications about all what was going so wrong before the corruption was really ripe enough to handle.

      • I didn’t want to go all out like this, but my button didn’t stop. As this isn’t proofed for honest moral considerations, it might not say the same as the corrected one below, and I’m sorry about that. It can be overlooked and hopefully Emmeline will rescind it since I disavow it. Please Emmeline, if you are willing to believe that, that was sent hastily and in error by forgetting what my obligations were in regard to freedom of expression. My bad.

    • bpd – I think they realize that they have an ad hoc argument in hand, so they are intentionally aiming not to highlight the things you suggest. What that is not nefarious, but only arises from misconception, would motivate them to throw their winnowing out of casework by example idea into the mix? Desire for publication and knowing you can’t publish anything great, since your theories haven’t shown definitive results, isn’t an adequate excuse in the helping professions for staking the claim to your turf, either. But I would suppose that they could only be meaning and hoping to also gear something back having to do with external criticism by juggling some appearances and changing up the pitches and smart talk overlays, and then add to that good work with the intention to suggest stimulating new empirical results by changing the population arrested for behavioral healthcare’s scientific purposes. Meanwhile, you surely thought of all this, and still more understanding was behind your reply, no doubt, as indicated by your reading and the link you enabled. I only want to add that having schizophrenia as the golden ring of all that psychiatry means to neuroscience and psychiatry’s own public relations efforts, for brandishing selectively in reaction to changing purposes, particularly whenever the chips are down, keeps it as an insitution safe from lethal or decimating harm in its coercive formulation, as long as the Academy and the press like most things most the way it needs and likes things, too. We are just waiting around if we aren’t focussing on movement principles almost verbatim as laid out in the Szaszian critique, and newer alternative human rights approaches very like it in their purposes. It gets hard for most people to see what gives the lie to every little justification for intervention as suits the beast we are fighting, and fighting with it to get fixed up nice isn’t going to make the press less lazy or higher education more socially determined about trying do what’s right for us all. We will just see more people there than ever in those professions getting along with each other, staying busy praising the kind of opportunity freedom gave them, and damning the poor communications about all what was going so wrong before the corruption was really ripe enough to handle.

      • Thanks for replying – I couldn’t understand the meaning of your message completely – it looks like maybe you wrote it in a rush? But I didn’t sense anything offensive about it, and the parts I did understand in what you said I agreed with.

        It’s sad because more people understood the work by people who have truly helped “schizophrenics” become emotionally well, like the authors I listed, then a lot of these early treatment programs would be blown out of the water as woefully inadequate.

        I like Macchiavelli’s quote below; it’s relevant to why people cling to the myth of nonexistent schizophrenia, and the myth of psychosis’ incurability:

        “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries, who have the laws in their favor; and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.”

        • bpd – You are real help in the middle of expecting none, for people you work with, I think. Any questionably meritorious conduct at all, and no intent to hit you with some disregard of some kind in particular was my worry above. Since I experience disorder of agency, getting at my intentions before enacting my response is the required nature of the vigilance that let’s me take part and anwer for myself in the equation. My attention to one thing–worse than for most people–drops a blind over my appreciation for something just set into the background for a moment while I see what I believe, for instance. Or feel and mean to relate. The intentionality and the constructs associated with it are of reduced functioning in their value. You are totally right that I have to hang with the “idea” of things happening and wait on the feedback for my impressions to matter right. Cheap popular cultural vehicles, for instance–most all we generally see, that is–often grant me the final elements of the cathartic response some pleasantries or shoot-’em-ups ahead of schedule, no matter how sappy and fast action or how moddish and restrained. I drop the most idiotic tears for nothing because of what has gone “untreated”. Anyway, my message was about appropriating the authors viewpoint and the range of ambitions likely operating for their meanings in the contexts in which they like their work and make it how they live. I hope that starts you on the road to better knowledge, somehow. I believe you know that the authors are not just competing with their wits and their contents as put on offer, who are pro-psychiatry however it can stay arranged and not tell all its problems to the world. They want to push some things to research and some to the press and some to each other and their minions and whoever else is compliant, through however many alliances they can identify in their social arrangements. They want not to make anything much explicit that suggests a different power play option than what the “science responds to” or the “science promises and warns”. But they are all coming from the area of discourse that is actually that of opinion, and almost not one says anything scientifically right about good protocols and P. R. measures that alone could reduce harm. They want nothing right if it means things stay the same in money and job security terms, in entitlement terms so that arrests make them profits and give them credibility, and so that little vague reminders of the behavioral healthcare double-dutch with facile and cowardly therapists seem unproblematic. Look at Psychology Today and its free advertising for whatever insane or intervention called some game term. Since these institution that constitute the paradigm under discussion on MIA–inasmuch as Bob Whitaker has not focussed on the extrajudicial nightmare of most consequence just yet–are licensed and legal to use for doing nothing great, we very predictably can expect to keep watching them do nothing great in either APA or NIMH stated terms even, all the while continually misrepresenting the relevant value judgments about case outcomes and, hence, reform needs, so obscenely. My problem above ended up having left my particulars too obscure in case it mattered that someone could follow some of the considerations. People making waves as best they can now are not just reinventing Szasz or replacing his terminolgy with their own, however similar their take on the meaning of shared principles for promoting abolishment–as that implies no mistakes allowed from coercion or labelling anymore. And be your own doctor.

          • Hi, I’m still not sure that I understand a lot of what you said. In some parts of your message, the way you use grammar and syntax is unfamiliar to me. Anyway, I understand you intend well and I agree with several of the points you made, so thank you.

        • bpd – Sorry and sorry ahead of time. Your responses were perfect for the occasion, it seems to me, and I don’t need anything ever in reply unless some inspiration commands it. But I still would appreciate your reading any comment of mine if it naturally comes to your attention that you want to. We all are pretty happy with that, who are mainly ignored pretty much of the time. When my ability to stay articulate about this whole range of issues becomes the thing that matters, and usually I’m never–you know–put to the test for anything much, then that will be what I work on right away. Thank you for your accurate help in taking charge of yourself as a fellow thinker and talker somewhere out there and prompting my comprehension into gear about putting some attention on the fact that of making this happen. Your very direct and courteous, considerate manner of sharing your knowledge is what made me want to work at this, and those things are allowed to take shape here. Well, I got clear and learned to understand some of the commentary that I encounter here better from now on–until I maybe don’t again with various types of opinionated expression. I had to write the essay version for what I believe to be the true purposes of biopsychiatry and, additionally, the real incidental meanings of its use of the medical model for deflecting criticism of its improper legal authority. That improper authority to detain and coerce is solidly and unopposedly maintained as an historical aberration of gross proportions where most of us live, and is disgusting to me for what it means to have it existing in the United States. That is the main issue at the heart of the survivor movement’s needs for something to call out as insufficiently noted, in my view. And that demurring about and backstaging of the human rights issue is the business as usual clause to be seen with all the concerted mewling around about reforms needed that the system can “survive” not getting our time and attention enough unless they count a dozen more new ways than for our habeas corpus and due process related rights before the Law itself represents a lose or win all racket for the moneyed and most bureaucratically influential powers that be, in my eyes. We should maintain a strong focus on the abolishment of forcible detention and every obvious or subtle type of practical coercion at all times, too, and act like we get the point of why unless we are out of the world asleep. The freedom and opportunity issue is what topically should never get deflected one bit, as everyone knows who wants to live here. Psychologists can make it very easy to understand that behavioral healthcare experts will lie if they see the chance to influence the legal process along the lines of who gets to keep their rights equal and who won’t. They should work to establish little else in the public’s imagination, but hardly ever show work on this psychologically relevant problem. In your case here, however, I mainly had not got my thought clear about something else, totally–more of a David Healy and Al Francis office procedure issue than one for getting patient advocacy working fairly and safely in this country, like we were both considering here, it’s safe to say. To wit: Mortimer and Brown haven’t got the right to disagree with care options that work better or else differently and yet still just as well, much less to squelch the fact of the matter with writing the traces of these competing views out of existence in any of their work-related thoughts that get published as they thought them in mere biopsychiatric terms. Any time psychiatrists working with this foolishly granted extra-judicial authority in their favor put up the bio-option, they owe us the clearer picture that science can already have seen by then to give everyone about behavioral healthcare solutions–side by side. The role of entitlements in this system based on this giant silent majority of careproviders with their “response” on legal rights abuses is at a ground swell and support for freedom of expression seen on the Left at an all time low. From the viewpoint of any of this allied mental health industry’s representatives or any of their commerce-friendly advocates for reform measures that this current group of caregivers can “survive” is the biggest joke going around for those of us who mean to criticize treatment insufficiencies and rights abuses carefully, fully, and well. The deficiency in level of intellectual commitment reigning throughout the allied mental health professions, taking them as if represented in a state of full employment according to available positions, as well as that for the higher educational departments in synchrony with their aims, comes that meaningful one fraction of a second behind legal rights in importance for survivors as an essential issue. However, we are led to the same point of conclusion through this bifurcation. The rights issues lean on the myth of mental illness. The myth of mental illness would itself become pleasant as a good, kind, helpful source of humor, if the allied mental health industry representatives in charge of training, magazines and whatnot in their own and their colleagues favor would choose not to keep mandated treatment the live legal option for biopsychiatry that it is. All sorts of unhelpful and routine medico-therapeutic state advocate ideas would look dangerous to carry on about that get constantly bandied about her in shifting forms. To keep their Obamacare entitlements appropriately easy to depend on, helping professionals in the psychologically needy or the psychiatrically diseased arena would suddenly really have to earn their keep. They owe us, and not the other way around, who want us to handle them feathering their nests while patients die from the killer silence about mental illness as a myth and the fact holding that our degraded citizenship status is its meaning. Some caregivers who blog here do OK with that term of engagement with survivors and remain solidly determined advocates for them above all else. I wish the others had to take it sink or swim, instead of getting propped up the petty reform movement lies. Is there a chink in the wall for the fateful deluge to end the unity between power and psychiatry, really? With all this closely held opinion-and navel-gazing going on about the civil rights “question”, I doubt it. But we still should try to count at everything that matters: that’s all right.

    • Sounds like we ran into similar nightmares, although it was a board member of my kid’s school (and maybe his pastor friend, too) that was / were the pedophiles. I’m sorry about all you and your children have gone through, I hope they are doing alright.

      And yes, power can be intoxicating and addictive, although some powerful people are respectable first. Although the respectable and intelligent seem to have lost the power in this country to the evil bankers and psychopathic corporations our founding fathers warned us about.

      It’s a shame, and so many are blind to the reality.

  3. There appears to be numerous problems with Early Psychosis Intervention programs. One is that they tend to be diagnosis based, and tend to push the use of anti-psychotic medication. If one works outside of hospital system one learns that there are many youth who have one episode of a schizophreniform psychosis, but if treated conservatively with the emotional and social issues attended to, may not have further episodes. So these programs may tend to over diagnose and over treat medically and under treat psychologically. Any hospital based program will tend to have a predetermined idea of diagnoses, modalities and outcome expectations. Youth who show symptoms of psychosis, like anyone else, are best off treated as individuals with in depth assessments of all possible causes of symptoms.

  4. there are no mental illnesses, just weak people rebelling against their oppressors, often family members.

    Psychiatry creates a livestock of weak, poor, abandonned people by drugging them and destroying their brains and bodies. Then these people become their preys and they keep destroying them even more. They are creating victims who will be abandonned by everyone and left to their infrastructures that are actually prisons, not hospitals.

    The more one patient/customer/victim protests, the more he/she is drugged/destroyed by the drugs which are in fact designed to do so. Slowly destroy people from the inside when they ve already been destroyed psychologically by those who sent them there, in Hell.

    All statistics about drugs are fake, and neurolpetics dont help anyone, they destroy , disable weak people who are then emprisoned for life in jails known as hospitals. Most people would better go to jail than in psychiatric hell.