Should add that in the US early intervention services have focused on “coordinated specialty care.” RAISE-ETP showed some benefits for this in FEP, but I think we can agree that team based care with psychotherapy, vocational rehab and family psychoed would likely be helpful at all stages of illness.
A fascinating topic, well explained. As a layperson & parent, one anxiety I have about early intervention in psychosis is its potential to justify an over-use of antipsychotic drugs, especially in young people. You do a good job describing the profile of a preventative drug, like statin -- it must be well tolerated and have few negative side effects. My purely anecdotal experience of the world is that antipsychotic drugs impair intellectual development, creativity, and sense of self. Your position in the UK, working within the context of the NHS, might be different from my perspective here from America, where I see many institutional incentives for at-risk youth programs, rehab and halfway houses, to over-rely on antipsychotic drugs to make their jobs easier, frankly. The worst-case scenario, which should be avoided at all costs, is that these drugs become a mechanism of control rather than a treatment. The potential is there, especially in a private and privatized system.
Thanks for sharing this perspective. The psychiatrists I have worked with are generally judicious about the use of antipsychotics - these are powerful medications after all! The one exception might be the use of very low dose antipsychotics in people at risk for psychosis, without much evidence of benefit.
That's good, but the overall trends are not good, both in UK and US. In the US, we experienced a troubling growth in pediatric prescription of antipsychotics before 2010, with stabilization in rates since then, but in UK it's still going up. "Antipsychotic medication use is substantially higher for youth in the United States than in most other developed countries."
It looks like a lot of concern is around prescribing ‘off label’ for other disorders. I don’t think early intervention would be responsible for rates of antipsychotic use in children under 14, for example, as most services have this as their lower age limit.
The topic of antipsychotic use in children probably warrants a post of its own!
Fantastic review! Thanks.
Should add that in the US early intervention services have focused on “coordinated specialty care.” RAISE-ETP showed some benefits for this in FEP, but I think we can agree that team based care with psychotherapy, vocational rehab and family psychoed would likely be helpful at all stages of illness.
Yes, I do recall positive results from this trial, with some benefits maintained at five year follow-up.
The US and UK healthcare system seem so different that I’d be reluctant to draw any conclusions
A fascinating topic, well explained. As a layperson & parent, one anxiety I have about early intervention in psychosis is its potential to justify an over-use of antipsychotic drugs, especially in young people. You do a good job describing the profile of a preventative drug, like statin -- it must be well tolerated and have few negative side effects. My purely anecdotal experience of the world is that antipsychotic drugs impair intellectual development, creativity, and sense of self. Your position in the UK, working within the context of the NHS, might be different from my perspective here from America, where I see many institutional incentives for at-risk youth programs, rehab and halfway houses, to over-rely on antipsychotic drugs to make their jobs easier, frankly. The worst-case scenario, which should be avoided at all costs, is that these drugs become a mechanism of control rather than a treatment. The potential is there, especially in a private and privatized system.
Thanks for sharing this perspective. The psychiatrists I have worked with are generally judicious about the use of antipsychotics - these are powerful medications after all! The one exception might be the use of very low dose antipsychotics in people at risk for psychosis, without much evidence of benefit.
That's good, but the overall trends are not good, both in UK and US. In the US, we experienced a troubling growth in pediatric prescription of antipsychotics before 2010, with stabilization in rates since then, but in UK it's still going up. "Antipsychotic medication use is substantially higher for youth in the United States than in most other developed countries."
https://www.manchester.ac.uk/discover/news/researchers-reveal-worrying-rise-in-antipsychotic-prescriptions-for-children-and-young-people/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778027/
https://www.sciencedaily.com/releases/2020/11/201110112532.htm
It looks like a lot of concern is around prescribing ‘off label’ for other disorders. I don’t think early intervention would be responsible for rates of antipsychotic use in children under 14, for example, as most services have this as their lower age limit.
The topic of antipsychotic use in children probably warrants a post of its own!