Early Detection and Intervention in Psychosis is published at a timely juncture for an Irish readership; the health service executive is currently developing a National Clinical Programme for Early Intervention in Psychosis. The book is written by some of the foremost experts in the field, including Patrick McGorry and Paolo Fusar-Poli. The concept of early intervention is not unique to psychosis; there are precedents in other areas of medicine such as cardiovascular medicine and public health. Support for early intervention in psychosis does not, however, have unqualified support in clinical and research communities. This book attempts to provide the basis for a ‘shift in the timing and nature of clinical care’ for those experiencing, or at risk of, early psychosis.
Whilst it is quite a scientific piece of work, the book is reasonably accessible and each chapter commences with an abstract that summarises the chapter’s contents. The book has six sections: overview, clinical assessments, neuroimaging, neurocognitive and neurophysiological assessments, early intervention in emerging psychosis, and conclusions and future perspectives. To the uninitiated there is a large number of concepts and corresponding acronyms with which to become familiar; attenuated positive symptoms, duration of untreated psychosis (DUP) and first episode psychosis (FEP) to name but a few. Knowledge of the field is not presumed, and the overview does a reasonable job of introducing the reader to these concepts.
One of the most contentious aspects of early detection is the diagnosis of a psychosis high-risk state, that is, the preclinical phase of frank psychotic illness. The prospect of preventing or delaying the onset of psychotic disorders is compelling, and there is precedence in other conditions, for example, cancer and diabetes. The authors present an excellent description of the clinical signs of the high-risk state and clinicians unfamiliar with these signs would find this section of the book very informative. However, there are potential problems in diagnosing the psychosis high-risk state, for example, the encroachment of psychiatric diagnoses into the sphere of normal mental states (see Saving Normal by Allen Frances from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV taskforce). Notably, the psychosis high-risk state has been confined to the section of mental disorders in need of further research in DSM-V. Early Detection and Intervention in Psychosis recognises the limitations to, and potential pitfalls of, the psychosis high-risk state. However, the book lacks a systematic approach to addressing the associated problems with the diagnosis, notwithstanding the chapter given over to stigma.
Sandwiched between the more clinically oriented sections of the book is a description of the neuroimaging, neurocognitive and neurophysiological correlates of early psychosis. This section may appeal more to an academic than clinical audience, although it is worth noting that Dwyer and McGuire’s chapter of magnetic resonance imaging findings is impressively concise and accessible. Additionally, there is a superb description of the methodological challenges inherent in this area of research included in the chapter on neurocognition and motor functioning in the prediction of psychosis. Studerus, Papmeyer and Riecher-Rossler describe the difficulties recruiting and retaining from this clinical population, and highlight the methodological and statistical shortcomings of research performed in the area to date. As somebody who has attempted to perform clinical research in psychotic disorders I can attest to the challenges in engaging in longitudinal research individuals who may be migratory, lacking in insight or using illicit substances. I think a whole chapter should have been given over to this subject. It is important to high light short comings of existing research; not to fuel a negative, critical appraisal of the area, but to outline how future research could be improved.
The penultimate section on early intervention in emerging and early psychosis is comprehensive and very interesting. There may be some controversies associated with the early intervention in psychosis movement; however, the toxic effect of a prolonged DUP is not one of them. Pharmacological, nonpharmacological and psychosocial interventions for psychosis high-risk state and FEP are described in this section. In excess of 1000 individuals have been treated in randomised controlled trials of various psychological modalities in relation to preventing transition to psychosis. The authors of this chapter argue strongly in favour of psychological therapies as first-line treatment in the psychosis high-risk state. The chapter on nonpharmacological substances in early intervention describes a number of interesting targets (e.g. N-Methyl-D-Aspartate, N-acetyl-cysteine) although, being a book, it is unfortunately already somewhat outdated, for example, in relation to the most recent findings on omega fatty acids as an intervention. The chapter on pharmacological interventions is an excellent source of information for clinicians prescribing antipsychotic medication. This chapter covers treatment guidelines and dosing, duration of treatment and some controversies associated with antipsychotic prescribing.
I enjoyed reading Early Detection and Intervention in Psychosis. State of the Art and Future Perspectives. At times it was difficult to shrug off a sense that the book was written by early interventionists for early interventionists and it is perhaps more weighted towards a research than purely clinical audience. However, the book contains a wealth of nuanced and clinically relevant information garnered by specialists who have spent decades engaging, assessing and treating at-risk and frankly psychotic patients. There is a huge amount in this book to engage anybody with even a passing interest in this continually evolving area of mental health research and care.
Conflicts of Interest
None.
