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Early Intervention in Psychosis: A Case Study on Normal and Pathological

  • Constantin TranulisEmail author
  • Lawrence Park
  • Laura Delano
  • Byron Good
Cultural Case Study

Abstract

Accumulating evidence suggests that delays in receiving treatment are associated with poorer prognosis and longer periods of unneeded suffering. The duration of untreated psychosis (DUP) is considered to be one of the most important determinants of outcome in the first episode of psychosis. However, the focus on decreasing the length of untreated illness tends to overlook the difficult task of making sense of psychotic experiences during a first episode. Using a qualitative analysis of narratives obtained from interviews with an individual and her husband, we examine what delayed her seeking help, how she became convinced that she needed treatment and what this meant for her and her husband. Additionally, we look at the five-year development of both a literal and a figurative space within which both the subject and her husband came to utilize, whether consciously or unconsciously, the ‘stories’ of her psychotic experiences to construct a shared and even ‘safe’ and familiar means of spousal connection. The exploration of this shared space reveals the normative and moral values embedded in the concept of DUP and suggests alternative ways of understanding the help-seeking behaviors in early psychosis.

Keywords

Early intervention in psychosis Duration of untreated psychosis Narrative analysis Schizophrenia 

References

  1. Bentall, R. P. 2004 Madness Explained: Psychosis and Human Nature. London: Penguin Books.Google Scholar
  2. Birchwood, M., P. Todd, and C. Jackson 1998 Early Intervention in Psychosis. The Critical Period Hypothesis. Br J Psychiatry Suppl 172(33):53–59.Google Scholar
  3. Cohen, A., V. Patel, R. Thara, and O. Gureje 2008 Questioning an Axiom: Better Prognosis for Schizophrenia in the Developing World? Schizophr Bull 34(2):229–244.CrossRefGoogle Scholar
  4. Corin, E., R. Thara, and R. Padmavati (2004) Living through a Staggering World: The Play of Signifiers in Early Psychosis in South India. In: J. H. Jenkins and R. J. Barett (eds) Schizophrenia, Culture and Subjectivity: The Edge of Experience. Cambridge Studies in Medical Anthropology. Cambridge UK: Cambridge University Press, pp. 110–145Google Scholar
  5. David, A. S. 1990 Insight and Psychosis. British Journal of Psychiatry 156:798–808.CrossRefGoogle Scholar
  6. Good, B. J. 1994 Medicine, Rationality and Experience. Cambridge, UK: Cambridge University Press.Google Scholar
  7. Hafner, H., W.F. Gattaz, and W. Janzarik 1987 Search for the Causes of Schizophrenia. Berlin: Springer Verlag.Google Scholar
  8. Hafner, H., A. Riecher-Rossler, M. Hambrecht, K. Maurer, S. Meissner, A. Schmidtke, B. Fatkenheuer, W. Loffler, and W. van der Heiden 1992 IRAOS: An Instrument for the Assessment of Onset and Early Course of Schizophrenia. Schizophr Res 6(3):209–223.CrossRefGoogle Scholar
  9. Harrigan, S. M., P. D. McGorry, and H. Krstev 2003 Does Treatment Delay in First-Episode Psychosis Really Matter? Psychol Med 33(1):97–110.CrossRefGoogle Scholar
  10. Harris, M. G., L. P. Henry, S. M. Harrigan, R. Purcell, O. S. Schwartz, S. E. Farrelly, A. L. Prosser, H. J. Jackson, and P. D. McGorry 2005 The Relationship between Duration of Untreated Psychosis and Outcome: An Eight-Year Prospective Study. Schizophr Res 79:85–93.CrossRefGoogle Scholar
  11. Johns, L. C. 2005 Hallucinations in the General Population. Curr Psychiatry Rep 7(3):162–167.CrossRefGoogle Scholar
  12. Kay, S. R., A. Fiszbein, and L. A. Opler 1987 The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull 13(2):261–276.Google Scholar
  13. Kleinman, Arthur 1988 The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.Google Scholar
  14. Lewis, Aubrey J. 1934 The Psychopathology of Insight. Br J Med Psychol 14:332–348.Google Scholar
  15. Marshall, M., S. Lewis, A. Lockwood, R. Drake, P. Jones, and T. Croudace 2005 Association between Duration of Untreated Psychosis and Outcome in Cohorts of First-Episode Patients: A Systematic Review. Arch Gen Psychiatry 62(9):975–983.CrossRefGoogle Scholar
  16. McGlashan, T. H., and J. O. Johannessen 1996 Early Detection and Intervention with Schizophrenia: Rationale. Schizophr Bull 22(2):201–222.Google Scholar
  17. Norman, R. M., and A. K. Malla, A. K. 2001 Duration of Untreated Psychosis: A Critical Examination of the Concept and Its Importance. Psychol Med 31(3):381–400.CrossRefGoogle Scholar
  18. Norman, R. M., A. K. Mallal, R. Manchanda, D. Windell, R. Harricharan, J. Takhar, and S. Northcott 2007 Does Treatment Delay Predict Occupational Functioning in First-Episode Psychosis? Schizophr Res 91(1–3):259–262.CrossRefGoogle Scholar
  19. Obeyesekere, Gananath 1990 The Work of Culture: Symbolic Transformation in Psychoanalysis and Anthropology. Chicago: University of Chicago Press.Google Scholar
  20. Saravanan, B., K. S. Jacob, S. Johnson, M. Prince, D. Bhugra, and A. S. David 2007 Belief Models in First Episode Schizophrenia in South India. Soc Psychiatry Psychiatr Epidemiol 42:446–451.CrossRefGoogle Scholar
  21. Smith, Daniel B. 2007 Muses, Madmen, and Prophets: Rethinking the History, Science, and Meaning of Auditory Hallucinations. New York: Penguin Press.Google Scholar
  22. WHO 1973 Report of the International Pilot Study of Schizophrenia. Geneva, Switzerland: World Health Organization Press.Google Scholar
  23. Wilson, W. H., T. A. Ban, and W. Guy 1986 Flexible System Criteria in Chronic Schizophrenia. Compr Psychiatry 27(3):259–265.CrossRefGoogle Scholar
  24. Winnicott, Donald Woods 1971 Playing and Reality. London: Tavistock.Google Scholar
  25. Wyatt, R. J., and I. Henter 2001 Rationale for the Study of Early Intervention. Schizophr Res 51(1):69–76.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Constantin Tranulis
    • 1
    Email author
  • Lawrence Park
    • 2
  • Laura Delano
    • 1
  • Byron Good
    • 1
  1. 1.Department of Social MedicineHarvard Medical SchoolBostonUSA
  2. 2.Department of PsychiatryMassachusetts General HospitalBostonUSA

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