The Tips Project: A systematized program to reduce duration of untreated psychosis in first episode schizophrenia

Schizophrenia is the single most costly disorder between as well the serious psychiatric disorders as for the larger somatic diseases as cancer, vascular diseases (1, 2, 3). In all NATO countries combined, the costs connected with this disorder are estimated at over 1% of the gross national budget (4). While the worldwide rate of new cases (incidence) is low (1 per 10000 per year) (5), the disorder’s lifetime prevalence is high because the disorder often results in chronic deficits in mental functioning. The suffering connected to the schizophrenia spectrum disorders for the affected individuals and their families is enormous and beyond measurement. Although contemporary treatments as neuroleptic medication, family psychoeducation and assertive continuity of care has demonstrated efficacy in clinical trials (6), these treatments are essentially palliative and must apparently be provided indefinitely because discontinuation leads to clinical deterioration in almost every case. Schizophrenia and related psychotic disorders can be seen as disorders developing through different stages or phases. Sullivan (7) wrote that the psychiatrist sees too many end states and deals professionally with too few of the prepsychotic. Kraepelin stated that if no essential improvement intervenes, in at most two or three years after the appearance of the more striking morbid phenomena, a state of weakmindedness will be developed which usually changes only slowly and insignificantly (8). One model for illustrating these different phases is outlined in figure 1.