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| In most cases the delay between the onset of psychotic symptoms and first treatment is surprisingly long: |
| The mean duration of psychosis before first treatment is one to two years. (McGorry and Jackson, 1999). |
| The longer individuals with psychosis remain untreated, the greater the opportunity for serious physical, social or legal harm: |
| The long period of untreated psychosis before first treatment has been shown to involve distress for individuals and their relatives including ineffective and demoralising attempts to get help and various traumatic events. Approximately 20 to 30% of young people experiencing their first onset of psychosis hove been found to hove been a danger to themselves or others before receiving effective treatment, including suicide attempts (Lincoln and McGorry, 1999). |
| Social and personal disability develops aggressively in the ‘critical period’: |
| Where disabilities develop, they usually do so during the first 3 years — the so-called ‘critical period’. Unemployment, impoverished social network, loss of self esteem can develop aggressively during the critical period; the longer these needs are not dealt with, the more entrenched they become. (Birchwood et al, 1998) |
| Early treatment with antipsychotic medication has been shown to improve the long-term course of psychosis: |
| Long duration of psychosis prior to treatment with antipsychotic medication has consistently been shown to be related to poor long-term outcome: giving neuroleptic treatment early, improves outcome (Carbone et at, 1999; Wyatt, 1991). |
| Delays in the treatment of psychosis have been associated with substantially higher health care costs for at least three years after first treatment. |
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Longer untreated illness is associated with longer first and second admissions to hospital (Wiersma et al, 1998), giving rise to higher healthcare costs. (McGorry and Jackson, 1999). |
| Long term ‘treatment resistant’ symptoms develop during the ‘critical period’. |
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Long term, persisting, troublesome symptoms develop within the ‘critical period’ (Mason et al, 1995; Harrow et al, 1995). |
| The ‘revolving door’ begins in the ‘critical period’. |
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Where a pattern of repeated relapse develops, it begins during the critical period (Mason et al, 1995; Wiersma et al, 1998).
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