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Gurpal

Online Essay Club No. 29:  Early Psychosis

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After the winter break, the online essay club starts again. Starting from today, one essay question will posted each week on this forum. This will last for 6 weeks, ending four weeks before the Spring 2003 Part II written exam. The questions will be topical and designed to encompass a wide range of knowledge. Please contribute! I'd encourage you to post complete essay plans as previous forum members have done but, if you prefer, feel free to post just one or two points that you would raise in your answer.

Your 90 minutes start now...

Essay: Discuss the evidence for and against early interventions in psychosis.

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Very topical issue, a lot of recent research and publications on DUP ( duration of untreated psychosis).

But I think this essay was asked last year, spring 2002.

So do they repeat it so soon?

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hi doc, even if the college used the same question again, you'd still get the same spread of marks, i think.

someone i know did a business studies degree where they were all given the questions before the exam to prepare their answers - everyone didn't get a first!

there are only so many questions the college can ask. i think this is true especially for the osces in part 1.

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Hi guys,

This essay came in 2002, is it not yet time for a repeat?

Let us try out a plan!

Intro

Define psychosis

Does it include the prodromal period?

Should we include causes to highlight the possibility of treating the organic/drug induced?

What does early mean

day 1 or day 2 or day3...

week 1 or week 2 or ...

obviously not before

can also sometime mean that the psychosis is not t that florid

What does intervention mean?

Biological

Psychological

Social

admission and sometimes forced

Duration of untreated psychosis is so important in prognosis

Body

Advantages of medication early on

more likely for patient to accept Rx

home treatment may be considered

lower doses may work

shorter duration of illness

Advantages of Psychological treatment early on

Understand illness and working with insight

Family work to reduce EE

Advantages of social intervention

Reintegration in society

School

work

Housing

finances

support network

Advantages of admission (and compulsory) obviously to treat early and obtain above benefits. Prevent chaotic behaviour, risks to self and others, and indulgence in substance misuse and unsafe sex.

Disadvantages of early intervention are few but not unimportant.

-it happens that psychotic episodes subsides without medication

-side effects alienate patients to treatment

- forced admission is a very bad prognostic factor

- admission in itself is often wrong. Psychiatrists do admit patients just to cover their back. Especially off working hours patients get admitted before being seen by a psych. Sometime even without being seen by the GP(just a phone call from anxious relatives). A high number of patients do get discharged the following working day

-during the acute phase of psychosis it is a waste of time to do talking therapy.

Conclusion

In psychiatry there is not one single ideal answer but many good ones with both advs and disadvs. Individual cases need to be taken in their own merits. Nothing can replace thorough assessment and multidisciplinary management.

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good article in Jan '05 APT journal giving most of arguments both ways.

Early intervention in psychosis: obstacles and opportunities

Singh and Fisher Adv Psychiatr Treat.2005; 11: 71-78.

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