Prominent psychiatrists debate the pros and cons of early intervention for psychiatric disorders

Recently, Professor of youth mental health, Patrick McGorry and honorary professor Anthony Pelosi have gone head-to-head in the debate on whether early intervention is justified in major psychiatric disorders. Professor Pelosi argued that current evidence does not support sufficient benefit from early intervention to counterbalance any potential harm; however, Professor McGorry disagreed, stating that in his view early specialist treatment was essential. Professor McGorry argued that early intervention covers both early detection and the treatment of early stages of illness by way of appropriate psychosocial and pharmacotherapeutic approaches, noting that such intervention should be “as central in psychiatry as it is in cancer, diabetes, and cardiovascular disease”. In contrast, Professor Pelosi noted the difficult clinical judgements that are required to make prompt and accurate diagnostic assessments in order to facilitate appropriate care. He noted that of the large number of patients general practitioners and psychiatrists will see due to changes in emotions, thinking and behaviour, only a small minority will evolve into a serious psychotic illness. Given this, he questions the appropriateness of offering all patients antipsychotic drugs that have serious side effects. “So far, the evidence from randomised trials does not support the use of psychological therapies or drugs as preventive interventions,” he affirmed. He also stressed the dangers of overtreatment noting that in studies where psychiatrists referred selected patients to a schizophrenia prodrome clinic, only half went on to develop a psychosis. Professor Pelosi concluded that “it is time to divert resources to ordinary clinicians who are prepared to tackle the genuine challenges of treating and trying to prevent severe mental illnesses.” Professor McGorry stated that the evidence for early intervention is compelling noting that serious mental disorders increase mortality and may produce a lifetime of disability and unfulfilled lives. Given that the incidences of mood, anxiety, psychotic, personality, eating and substance use disorders are highest in adolescence and early adulthood, the potential benefits and cost-effectiveness of early intervention in mental disorders could exceed those of medical diseases, which typically develop later in life. Furthermore, he noted that treatment delay is independently linked to poor outcome in psychosis. “The risk to benefit ratio certainly shifts as treatments are offered earlier in the course of any illness,” he stated, “yet, as for other medical conditions, evidence indicates that a critical point exists in the natural course of mental disorders, after which therapy is less effective.” With regards to making diagnostic assessments, Professor McGorry pointed out that there are now operational criteria in existence that can predict imminent transition to psychotic disorder, which can help distinguish early clinical features of psychotic prodromal symptoms from benign conditions. According to Professor McGorry, the steps to successful intervention involve that the potential seriousness of unrecognised and poorly treated mental illness is understood, that youth friendly services for multidisciplinary care are developed, that clinical staging is embraced, and that demands for progress in mental healthcare are fulfilled....