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From Treating to Preventing Psychosis: Personal Perspectives

McGlashan, Thomas H. MD

The Journal of Nervous and Mental Disease: May 2015 - Volume 203 - Issue 5 - p 352–355
doi: 10.1097/NMD.0000000000000292
Original Articles

The psychoanalytic treatment model of neurotic disorders was applied “experimentally,” usually without concomitant pharmacotherapy, to psychotic disorders in the mid to late 20th century at a private institution (Chestnut Lodge) in Maryland. A long-term follow-up (by this author) essentially documented such an approach to be ineffective but suggested that initial treatment earlier in the development of disorder might prevent or ameliorate the “dementia” of dementia praecox. The opportunity to actually measure the effect of earlier detection and treatment became apparent to this author on sabbatical leave in Stavanger, Norway. The sectorized Norwegian health care system made it possible to engineer early detection of first psychosis in an “experimental” health care sector and compare their outcome to that of first onset patients from two control “usual detection” health care sectors. Early detection was engineered in the experimental sector with educational campaigns about the signs and symptoms of first psychosis targeting the sector’s doctors, educators, and the general public through massive educational campaigns. The result was clear. Early detection and treatment resulted in a significantly better symptomatic, social, and instrumental outcome in the experimental sectors compared with “usual detection” sectors, a difference that lasted up to a 10-year follow-up (and perhaps permanently). These events and findings will be reviewed to assert that intervention timing may be far more important than intervention type in the overall strategy of antipsychotic interventions.

Connecticut Mental Health Center, New Haven, CT.

Send reprint requests to Thomas H. McGlashan, MD, Connecticut Mental Health Center, 34 Park St, New Haven, CT 06405. E-mail:

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