答辩幻灯参考mcglashan：Moving Backward Toward Mechanism and Prevention.ppt

Schizophrenia: Moving Backward Toward Mechanismand PreventionT.H. McGlashan, M.D.Schizophrenia daysStavanger, NorwayNovember 5, 2008 Clinical Course of Schizophrenia Early Intervention Is Key TYPES OF PREVENTION Primary Secondary Tertiary Primary Prevention Reducing incidence of disorder Universal target population Prevention strategies treat the etiology - Fluoridation and dental caries - Seat belts and automobile deaths Secondary (Indicated) Prevention Reducing prevalence or severity of disorder - Delaying onset - Improving prognosis and long-term course High risk target populations - Family history of breast cancer - High cholesterol risk for cardiovascular disease Prevention strategies treat the risk - Prophylactic mastectomy - Cholesterol lowering agents and exercise Tertiary Prevention Reducing acuity and destructiveness of disorder - Reducing time actively ill - Reducing collateral damage (e.g., involuntary hospitalization) Clinically ill target population meeting diagnostic criteria Prevention strategies treat the disorder earlier and/or more aggressively - Early identification after onset Increasing awareness of disorder (e.g., education campaigns) Improving access to services - Early treatment - Continuous treatment if necessary Early Intervention Is Key Early Detection Research in theFirst Psychotic Episode The basic observation: Long duration of untreated psychosis is correlated with poorer clinical course and outcome Highly replicated correlation, but The causal direction of the association between long “DUP” and poor outcome is not at all clear TIPS Project The aim is to test in a multicenter trial whether reducing DUP in one healthcare sector will improve the prognosis/long-term course and outcome of first-episode, nonaffective, functional psychosis compared to healthcare sectors without a program for reducing DUP Design Overall Design First-episode, nonaffective