Improving outcome in schizophrenia: the case for early intervention.

The long-term course of schizophrenia, one of the world’s most serious public health problems, is generally regarded as one of chronicity and disability. Despite the availability of treatment, more than 50% of patients continue to exhibit moderate levels of “positive symptoms” such as delusions, hallucinations, and disorganized thinking and behaviour, and “negative symptoms” such as poverty of thought, volition and affect, and social and interpersonal withdrawal, and require long-term support and periodic admission to hospital. It is therefore important to find ways to improve long-term outcome. We reviewed the literature to examine the impact of strategies to improve longterm outcome, the factors that influence outcome and the evidence supporting early intervention as a means to improve outcome. The difficulties inherent in defining outcome are well documented. For this review, we used the description of Hegarty and colleagues, who stated that “patients considered improved in follow-up have been described as recovered, in remission, without symptoms, minimally or mildly symptomatic, improved without significant deficit, socially recovered, working or living independently.”