Early intervention and sustaining the management of vulnerability.

OBJECTIVE: The purpose of this article is to consider the issue of how long early intervention needs to be sustained to have a long-term impact on the course of psychosis.
METHOD: Factors relevant to the concept of secondary prevention in psychosis are discussed. The need for sustained intervention for long-term impact on psychosis is examined. Evidence concerning the length of time required for the maximal impact of early intervention services and interventions that have been demonstrated as effective in achieving long-term change is reviewed. The article discusses individuals of low and high vulnerability to schizophrenia and the interaction between this vulnerability and the length and type of treatment they require to change the deteriorating course of psychosis.
RESULTS: There is increasing evidence for the concept of a 'critical period' lasting up to 5 years after first presentation, during which the long-term level of vulnerability to relapse and disability may be determined.
CONCLUSIONS: For many highly vulnerable patients, early intervention must be sustained for a minimum of 3 years to prevent or limit the potential for early decline. A core unanswered question is whether effective early intervention prevents potential long-term disability or merely delays it.