Abstract
A quote in the introduction of this book by one of the contributing authors sums up why Early intervention in psychotic disorders is an important field of investigation. Tom McGlashan states that ‘like others before me, I tried to make a difference… but like the others my efforts were largely in vain. I came upon the scene too late; most of the damage was already done’. The focus of early intervention is not necessarily the intervention itself but the accuracy by which earlier signs are predictive of a person developing caseness. Therefore, the end game is improving sensitivity, specificity and predictability of clinical outcome. This NATO sponsored compendium of the proceedings of the Advanced Research Workshop on the Early Intervention in Psychotic Disorders held in Prague, October 1998, reads like a scientific text. The book is broken down into five major areas; risk and projective factors in the premorbid phase of psychosis; phenomenology, epidemiology and course in the prodromal phase of psychosis; early intervention in the prodromal phase of psychosis; early intervention in the onset phase; and neurobiology in the early course of psychosis.
The book draws from both European and American influences (as well as Australasian, most notably McGorry et al.'s work) in psychiatric research and as such is well-balanced and does not necessarily overemphasize the biological determinacy of psychotic illness often argued from American authors. The first area focusing on risk and projective factors is rather technical and attempts to use relatively sophisticated techniques such as path analysis and latent trait modelling. This will be of interest to researchers, particularly those wanting to employ structural equation modelling and other such techniques in their work. More familiar techniques such as regression and discriminant function analysis shed interesting insight into factors that may contribute to predicting the onset and course of psychosis.
The epidemiological portion of the book, to my mind, sheds little new light on the usual suspects of first degree relative familial risk, and the structural and functional disturbances in brain pathophysiology. The chapter by Häfner and Maurer provide a very comprehensive investigation of the prodromal features of psychosis. Despite their exhaustive research their conclusions are appropriately cautious, recommending that avoiding false positive cases can only occur once the first attenuated or clear cut psychotic symptoms appear. Their emphasis is to look clearly into the social disability that is caused by the onset of a psychotic illness and attempt to reduce these effects.
The later half of the book primarily deals with treatment effectiveness of different models of care. McGorry et al. provide some useful information on both psychological and pharmacological treatment of patients within the prepsychotic phase; however, these techniques should be well understood by Australasian readers. Other programmes most notably Falloon's in New Zealand, look at an integrated mental health care model within a primary health care setting. This chapter would be of interest to readers wanting to look at more integrated models particularly with services in semirural and rural areas.
The final chapter deals with the different theories which surround the aetiology and pathophysiology of schizophrenia including the biological theories of the neurodevelopmental and neurodegenerative models. The major concern with these theories are that the authors have not looked at grand integrative or causal models that may link these theories together. Although the authors argue great ‘… advances in molecular biology, genetics and clinical science’ little is said on how these separate sciences can be linked together within a causal framework. It is possible that true advances can be made when integrative models are proposed and methodologies are linked to examine their causal relationships.
On the whole this book will be of most interest to researchers within the area of early psychosis or early intervention of mental disorders. Readers who are interested in the latest developments of research in the area could also benefit from reading this compendium. For service developers and managers you may need to be a little more patient with the technical language in order to extract the important messages of how best to construct an intervention strategy for a patient with early signs of psychosis.