Early intervention in the pre-psychotic phase: a survey among expert and non-expert psychiatrists and general practitioners

Objectives: This study aimed at exploring views and comparing level of consensus across different groups of mental health professionals regarding the appropriateness of preventive interventions targeted at subjects with risk factors for the development of psychosis. Method: A survey was completed by 135 members of the International Early Psychosis Association ( IEPA), by 110 psychiatrists working in the Italian Region Emilia Romagna, and by 114 general practitioners working in the Province of Modena. The survey used three hypothetical case scenarios where a client, having tested positive for future psychosis to an imaginary infallible screening instrument, presents with either ( a) no symptoms and no interest in intervention; (b) no symptoms but requesting intervention; ( c) with some degree of anxiety and depression and requests assistance. Results: Mixed views prevailed on appropriateness of specific interventions across all groups regarding the hypothetical case scenario presented. Judgments varied according to clients' preferences and level of distress. IEPA members showed more inclination than other professionals to consider appropriate psychological and pharmacological intervention in an asymptomatic pre-psychotic state. The propensity for suggesting drug treatment was related to the belief that untreated psychosis causes neurotoxicity. Conclusions: Experts seem to have a more liberal view on the appropriateness of preventive interventions than community mental health psychiatrists and general practitioners. Further research addressing factors that influence experts' views seems warranted.