Merete Nordentoft

CORE- Copenhagen Research Centre for Mental Health, Department of Clinical Medicine, Rigshospitalet

Title: How early is too late? Possibilities for prevention and early intervention in psychosis

Abstract: Mental illness is associated with high burden of disease and it has severe individual and societal consequences. Genetic studies have identified risk genes for schizophrenia, but translation of genetic research into clinical practice is not possible yet. It will be of immense value to be able to intervene in risk groups identified before onset of psychosis and other severe psychiatric disorders. In the Danish High Risk and Resilience Study - VIA 7, 522 7-year old children and their families were thoroughly examined, and we identified a very vulnerable subgroup of children who were performing suboptimal in every domain. There are some ongoing trials in risk groups such as children of parent with schizophrenia and bipolar disorder.
In first episode psychosis, early Intervention services with team-based intensive case management and family involvement are superior to standard treatment in reducing psychotic and negative symptoms and comorbid substance abuse and improving social functioning and user satisfaction. The results of the OPUS-trial will be presented together with meta-analyses based on similar trials.
Results of long-term follow-up studies indicate that the prognosis of first episode psychosis is very diverse with the extremes represented by one group being well functioning and able to quit medication without relapse; and another group having a long-term chronic course of illness with a need for support to maintain daily activities. The latter is, in spite of many efforts, still poorly served.