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KMID : 0438320010080000021
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Pusan Journal of Psychiatry
2001 Volume.8 No. 0 p.21 ~ p.34
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Early Detection and Intervention in Schizophrenia
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김철권/Kim CK
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Abstract
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Early detection and intervention in schizophrenia offer promise, but the data of initial studies are still preliminary. Recently the rationale and need for those are increasing because the clinical research findings suggest that early intervention could change the deteriorative course and poor outcomes of schizophrenia.
Theoretically, early detection and intervention is possible at any stage of schizophrenia such as premorbid, prodromal, and onset, but it is more feasible to focus greater attention on the prodromal and onset phases clinically.
For the premorbid phase, early detection of schizophrenia is totally dependent on the vulnerability markers and the aim is to identify the cases at high risk for developing schizophrenia. But major challenges in this phase lie ahead such as the poor predictive potential and validity of the vulnerability markers, and low cost-effectiveness.
For the prodromal phase, the aim is to reduce the number of new cases of schizophrenia or to delay the onset of such disorder. The lack of specificity of prodromal features, the problem of false positives, and the risk of stigmatization create major challenges for attempts at early intervention in this phase.
For the onset phase, the aim is to reduce the duration of untreated psychosis. The principal ethical issues with this phase intervention is the danger of misdiagnosis.
One of realistic early intervention is close-in strategy that combines trait risk factors with a state and age risk factors to enhance the true positive pickup rate.
For the effective early detection and intervention in schizophrenia, it is the crucial step to educate the general practitioners for enhancing detection and reducing referral delays, and to provide a readily accessible system for assessment by specialized mental health workers.
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