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Our first correspondents are Jean Addington (University of Toronto, Canada), Max Birchwood (University of Birmingham, England), and Patrick McGorry (University of Melbourne, Australia), who sketch the highlights of the keynote and plenary talks at the recent International Early Psychosis Association meeting.
“Beyond the Crossroads”
17 October 2006. The 5th biennial meeting of the International Early Psychosis Association (IEPA) was held in Birmingham, UK, October 5-7. This meeting, with approximately 1,500 delegates from all corners of the world, has developed into one of the largest meetings focusing on psychoses. Keynote speaker Peter Jones (UK), presenting data from the AESOP study, demonstrated enormous contrasts in the incidence of psychosis according to standard epidemiological parameters. One such example is ethnicity, in that ethnic minority groups are at increased risk for all psychotic illnesses, but African-Caribbeans and Black Africans appear to be at especially high risk for both schizophrenia and mania. In attempting to further understand the gene-environment interaction, Jim van Os (The Netherlands) suggested that the onset of psychosis may be conceptualized as the abnormal persistence and deterioration of a normal developmental expression of psychosis in the general population. Paul Harrison (UK) offered an update on “genes for psychosis” with DISC1, Nrg1, and dysbindin still being the best supported. Other keynotes focused on long-term studies examining outcome from a first episode (Delbert Robinson, USA) and the impact of second-generation antipsychotics (René Kahn, The Netherlands).
The theme of the conference was “Beyond the Crossroads.” Patrick McGorry (Australia) in his plenary address reviewed the current status of early intervention in psychosis and demonstrated how far the field has come in terms of research and practice, but also how far it still has to go. Matcheri Keshavan (USA) reviewed the exciting and developing literature on the neurobiology of early psychosis that includes recent imaging genomics studies, studies that demonstrate functional and neurochemical brain changes in the premorbid and early phases of psychosis as well as altered structural and functional changes early in the illness that may predict outcome. Making a compelling argument, Max Birchwood (UK) proposed that emotional dysfunction in psychosis deserved study and intervention in its own right along with a better understanding of its role in psychosis. Barbara Cornblatt (USA) focused on the prodromal or clinical high-risk stage of psychosis and presented important evidence that suggests that these young people at clinical high risk are not just at risk for psychosis but also for poor functional outcome.
These keynote and plenary addresses reflect the themes and topics that were continued throughout the rest of the meeting where the symposia, the orals, and posters offered new data, new ideas, and discussion relevant for scientists, researchers, clinicians, and program developers. Many large treatment and prospective studies from different parts of the world such as LEO, OPUS, TIPS, PRIME, EPPIC 800, EDIE, AESOP, and others have been completed and their results were presented. In general, these studies support early intervention but also point to some of the methodological difficulties that would be expected in a somewhat small and relatively young field of outcome research, setting the stage for the next generation of outcome studies. Several debates occurred on controversial topics such as impact of cannabis on psychosis, use of medication in the prodrome, impact of reducing duration of untreated psychosis, and whether specialized services for early psychosis are needed. Studies of those at clinical or ultra-high risk for psychosis, once controversial, are now well established in that there were presentations from two large collaborative groups, the European Prediction of Psychosis Study (EPOS) (six sites) and the North American Prodrome Longitudinal Study (NAPLS) (eight sites), who were presenting their baseline data for the first time.
Our next meeting will be in Melbourne in 2008, where indeed we will move on beyond the crossroads to consider early intervention in affective psychosis, the impact of the early psychosis movement on schizophrenia, amongst many other exciting topics.—Jean Addington, Max Birchwood, Patrick McGorry