Early intervention in psychosis: Strategies, predictors and challenges

Background Psychotic disorders, such as schizophrenia, represent a substantial global health burden, particularly among adolescents and young adults. Early-onset psychosis (EOP), defined as the onset of psychotic features before age 18. It accounts for 11-18% of cases and is frequently associated with poor outcomes due to its interference with neurodevelopment and psychosocial maturation. Early intervention in psychosis (EIP) has emerged as a critical strategy in psychiatry aimed at improving long-term outcomes through timely, coordinated care. Objectives This review paper outlines the core components of early intervention services in psychosis, discusses predictors of outcome in EOP, evaluates the effectiveness and cost-efficiency of EIP programs, and examines challenges and adaptations required in low- and middle-income countries (LMICs), with a focus on the Indian context. Methods A comprehensive review of key studies, trials, and meta-analyses, using PubMed and Google Scholar databases, on EIP was conducted, along with comparative analyses of pathways to care in high-income and low-income settings. Indian studies were specifically referenced to contextualize findings. Results EIP programs aim to reduce the duration of untreated psychosis (DUP) and deliver multidisciplinary, assertive care during the first episode of psychosis. Predictors of poor outcomes in EOP include poor premorbid adjustment, greater symptom severity (especially negative symptoms), longer DUP, lower baseline intelligence quotient (IQ), and specific neurobiological markers such as reduced antioxidant levels and cortical thickness. International trials demonstrate that EIP services significantly improve clinical and functional outcomes, reduce relapse rates, and enhance medication adherence. Additionally, these services are cost-effective. However, in LMICs like India, major challenges in implementing EIP services include limited mental health infrastructure, workforce shortages, high treatment gaps, and reliance on informal care pathways such as faith healers. Conclusion Early intervention is a proven and cost-effective approach to improving outcomes in psychosis, particularly during the critical early years of illness. EIP programs are well established in high-income countries. In contrast, their implementation in LMICs such as India necessitates culturally sensitive adaptations, enhanced mental health literacy, and integration within existing public health frameworks