Why intervene early?
Interventions in the Critical Period
These studies of early psychosis suggest two main reasons to suppose that intervention targeted in the early years after onset is likely to have a disproportionate impact relative to interventions later in the course. First, in terms of long-term prediction and stability of functioning, three years after onset represents something of a watershed. Further decline is unlikely and improvements can be expected. Second, the initial psychological response of many young people is one of denial for a variety of reasons; such a defensive manoeuvre while adaptive may exacerbate early decline as it is directly linked to medication non-compliance. It is hypothesized that the early period after the onset of psychotic illness presents the greatest opportunity for secondary prevention. Efforts to stabilize or prevent developing disabilities, reduce treatment resistance and influence the way people appraise their illness may have a disproportionate impact compared to interventions later in the course of illness. Changing the early course of psychosis will be no easy task as the variables are numerous. A multimodal intervention will be essential and needs to be sustained over at least one year if not longer.