Early detection and prompt treatment of first-episode psychosis is becoming a public health priority. Most patients experience a long phase of illness before becoming psychotic, and it is during this time that much of the disability seen with psychotic disorders is established.

Dr. McGorry reported the results of a randomized, controlled trial of treatment with low-dose risperidone and cognitive behavioral therapy, compared with a nonspecific psychosocial treatment that did not include antipsychotic medication.

Fifty-nine patients were randomized to the two groups. They were assessed again after the six- to nine-month treatment ended and once more about one year after entry.

Of the 28 patients in the nonspecific treatment group, 10 become psychotic by the first follow-up. Only 3 participants in the specific treatment group showed symptoms of psychosis at first follow-up, with three additional patients developing psychotic symptoms at later follow-up.

Dr. McGorry outlined four major advantages associated with intervention before development of psychosis. If something can be done for patients during this long, pre-psychotic phase, major disability may be less likely to develop and stigmatizing behavior or incidents may occur less often. If psychosis does develop, duration of untreated symptoms may be shorter and hospitalization less likely.

In Dr. McGorry's study, treatment significantly affected transition to psychosis. More than 35% in the nonspecific group became psychotic during the study compared with 9.7% of patients receiving low-dose risperidone and cognitive behavioral therapy. Dr. McGorry concluded that intervention delayed the onset of psychosis, and called the results encouraging. He feels there is a need for more research. Until more information is available, he recommends that very high-risk patients be closely monitored. Antipsychotic medications should be withheld until the symptoms of a psychotic disorder are clearly seen.