Early intervention in the Indian context

Abstract

The last two decades have seen a concerted international effort at developing, implementing and evaluating early intervention in psychosis services (EIS). The impetus for this is the well-documented association between a longer duration of untreated psychosis (DUP) and a poorer outcome, the accumulation of disability preceding the emergence of frank psychotic symptoms and the emerging evidence of progressive neurobiological changes in the pre-psychotic and early stages of first-episode psychosis (FEP). Several robust clinical trials have confirmed the clinical and cost-effectiveness of specialist EIS in improving medium-term outcomes and functioning as compared to standard care. Almost all the work in this area, both clinical and academic, has been done in developed countries. The “at-risk” population for the emergence of psychosis—late adolescence and early adulthood—predominantly lives in countries such as India where DUP is much longer and service provision for psychosis is scarce, concentrated mainly in urban areas and a few large psychiatric institutions. This chapter will summarise the clinical and research foundations of the early intervention paradigm, review the evidence for the effectiveness of EIS in improving outcomes in early psychosis and discuss the possible application of the EIS model to the Indian setting. It will explore the training and resource constraints in implementing such a model in India, suggest a public health approach for screening, identifying and treating early psychosis within these constraints, and discuss EIS effectiveness and implementation research in an Indian EIS setting.