A risk reduction approach for schizophrenia: the Early Psychosis Intervention Programme

Schizophrenia is a serious mental disorder with a profound impact on patients, their caregivers and society. Most patients who develop schizophrenia experience a prodromal phase where there is a change in premorbid functioning prior to the onset of frank psychotic symptoms. Once psychosis sets in, the subsequent course can be variable but schizophrenia tends to run a chronic course, resulting in considerable disabilities. The prognosis of schizophrenia could potentially be improved by reducing the duration of untreated psychosis (DUP). The Early Psychosis Intervention Programme (EPIP) in Singapore adopts a risk-reduction approach. It seeks to reduce the DUP through public education, networking with the primary healthcare providers (general practitioners, counsellors, traditional healers), and the screening of conscripts into the Singapore Armed Forces. Integral to this programme is a service for those in the prodromal phase of psychosis, that addresses the concerns of stigmatisation and pharmacotherapeutic interventions. Our tertiary prevention strategies aim to reduce mortality and morbidity, and to improve the quality of the lives of the individuals diagnosed with this disorder through a comprehensive and holistic management programme that comprises case-management, the judicious use of antipsychotics, and various psychosocial interventions. Since EPIP's initiation in April 2001, there has been a steady increase in the number of individuals screened and accepted into the programme. Our networking strategy is gaining momentum and there has been a significant increase in the number of primary healthcare providers whom we have trained to identify early signs of psychosis. However, there remain various challenges which we are yet to overcome.