McGorry Patrick D, Yung Alison R
ORYGEN Research Centre, University of Melbourne, Department of Psychiatry, 35 Poplar Road Parkville 3052, Victoria, Australia.
Aust N Z J Psychiatry. 2003 Aug;37(4):393-8. doi: 10.1046/j.1440-1614.2003.01192.x.
To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled.
Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention services throughout Australia? (iii) how could some of these obstacles be overcome? and (iv) what else needs to occur?
Early intervention in psychosis aims to improve recognition and access, promote recovery from the initial psychotic episode, minimize secondary morbidity and reduce collateral damage. It may also prevent some brain dysfunction and damage, which may otherwise occur later in the illness. Despite the now growing body of evidence supporting the idea of early intervention, obstacles remain to its widespread adoption in policy and implementation, principally related to chronic under-funding of the public mental health system. Among the solutions proposed is the need to develop services with a youth focus, able to cater for young people with both psychotic and non-psychotic psychiatric disorders. These services should be well integrated with primary care and other youth orientated agencies.
We are hopeful that strong investment in early intervention and better services for young people will be among the highest priorities of the Third National Mental Health Plan. This is not only where the greatest public health burden lies, but also where cost-effectiveness of intervention is likely to be maximal.
探讨对精神障碍进行早期干预的基本原理，并探究早期干预服务广泛实施受阻的原因。
围绕精神病的早期干预探讨四个核心问题：（i）精神病早期干预服务的基本原理是什么，是否合理？（ii）在澳大利亚各地实施早期干预服务的障碍有哪些？（iii）如何克服其中一些障碍？以及（iv）还需要做些什么？
精神病的早期干预旨在提高识别率和可及性，促进从首次精神病发作中康复，将继发疾病的发生率降至最低，并减少附带损害。它还可能预防一些否则可能在疾病后期出现的脑功能障碍和损害。尽管现在越来越多的证据支持早期干预的理念，但在政策和实施方面广泛采用早期干预仍存在障碍，主要与公共心理健康系统长期资金不足有关。提出的解决方案包括需要开发以青年人为重点的服务，能够满足患有精神病和非精神病性精神障碍的年轻人的需求。这些服务应与初级保健和其他以青年人为导向的机构充分整合。
我们希望对早期干预的大力投资以及为年轻人提供更好的服务将成为第三届国家心理健康计划的最高优先事项之一。这不仅是最大的公共卫生负担所在之处，也是干预成本效益可能最高的地方。
