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Head To Head

Is early intervention in the major psychiatric disorders justified? Yes

BMJ 2008; 337 doi: (Published 04 August 2008) Cite this as: BMJ 2008;337:a695
  1. Patrick D McGorry, professor of youth mental health
  1. 1ORYGEN Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria, 3052, Australia
  1. pmcgorry{at}

    Psychiatric disease can take many years to emerge fully. Patrick McGorry argues that early specialist treatment is essential, but Anthony Pelosi (doi: 10.1136/bmj.a710) is unconvinced that current evidence of benefit is enough to balance the potential harm

    Early diagnosis and treatment is intuitively appealing and widely accepted in medicine. Over the past 15 years, early intervention has become established in psychotic disorders and must now be extended to other mental disorders. Early intervention covers both early detection and the phase specific treatment of the earlier stages of illness with psychosocial and drug interventions. It should be as central in psychiatry as it is in cancer, diabetes, and cardiovascular disease.

    Evidence for early intervention

    Mental illnesses have been called the chronic diseases of the young.1 The incidences of mood, anxiety, psychotic, personality, eating, and substance use disorders are highest in adolescence and early adult life.2 Serious mental disorders increase mortality and may produce decades of disability and unfulfilled lives. Thus, the potential benefits and cost effectiveness of early intervention in mental disorders arguably exceed those for medical diseases, which typically emerge later in life.

    Early clinical features can be difficult to distinguish from benign conditions and normal experience, leading to concerns about premature labelling. However, we now have operational criteria that not only indicate a need for immediate clinical care but strongly predict imminent …

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