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Clinical Atlas Prestige · Evidence-first

Psych VivasFoundations — prevention and early intervention

Psych Vivas · Foundations — prevention and early intervention

Prevention and early intervention — structured clinical viva

Fellowship viva on prevention frameworks, indicated care, DUP, EIS evidence, and UHR antipsychotic restraint.

clinical
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Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
FRANZCP/MRCPsych-style viva. Slide 1: table comparing universal school programme, selective perinatal pathway, UHR clinic, and early intervention psychosis team. Slide 2: median DUP 12 months. Slide 3: question — 'Should all UHR patients receive prophylactic antipsychotics?' Follow-ups cover Rose vs Gordon, Cuijpers depression prevention IRR, Correll EIS meta-analysis, clinical staging, and implementation failure.

Interpretation

Reveal interpretation

Slide 1 map. Place each row: school programme = universal (small average effects if psychological curriculum-based); perinatal high-risk = selective; UHR clinic = indicated; EIS team = early intervention after onset, not pure primary prevention.[1] Name Rose if examiner asks why universal still matters alongside clinics.[2]

Slide 2 DUP. 12 months is long. Define DUP as frank psychosis onset to adequate treatment. Longer DUP associates with worse early outcomes — improve detection, GP pathways, soft-entry youth access, reduce stigma delays. Still deliver full multi-element care when presentation is late.[7][8]

Slide 3 antipsychotics for all UHR. Answer no as default. Conversion is a minority outcome; network meta-analysis does not crown a single superior preventive package; metabolic harm and false positives matter. Offer structured assessment, comorbidity treatment, CBT-informed care, monitoring; reserve AP for specialist rationale or conversion/near-threshold severe cases.[5][6]

Staging follow-up. Earlier stages → safer, lower-intensity care; escalate with progression (McGorry heuristic).[3]

Depression prevention follow-up. Psychological indicated prevention reduces incidence (classic IRR ~0.78 framing).[4]

EIS follow-up. Correll meta-analysis: EIS > TAU; RAISE comprehensive care superior to usual community care on key outcomes — name multi-element components.[8][9]

Implementation follow-up. Evidence catalogues fail without workforce, fidelity, equity, and funding continuity (Campion public mental health implementation frame).[10]

Key points

Gordon + Rose together

Universal/selective/indicated design plus population strategy — clinics alone miss the prevention paradox.[1][2]

UHR restraint

Minority convert; AP not default; treat current need.[5][6]

FEP package

Shorten DUP + multi-element EIS (OPUS/RAISE/Correll lineage).[7][8][9]

References

  1. [1]Gordon RS Jr An operational classification of disease prevention Public Health Rep, 1983.PMID 6856733
  2. [2]Rose G Sick individuals and sick populations Int J Epidemiol, 2001.PMID 11416056
  3. [3]McGorry PD, Hickie IB, Yung AR, et al. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions Aust N Z J Psychiatry, 2006.PMID 16866756
  4. [4]Cuijpers P, van Straten A, Smit F, et al. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions Am J Psychiatry, 2008.PMID 18765483
  5. [5]Fusar-Poli P, Bonoldi I, Yung AR, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk Arch Gen Psychiatry, 2012.PMID 22393215
  6. [6]Davies C, Cipriani A, Ioannidis JPA, et al. Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis World Psychiatry, 2018.PMID 29856551
  7. [7]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients Arch Gen Psychiatry, 2005.PMID 16143729
  8. [8]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis JAMA Psychiatry, 2018.PMID 29800949
  9. [9]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
  10. [10]Campion J, Javed A, Lund C, et al. Public mental health: required actions to address implementation failure in the context of COVID-19 Lancet Psychiatry, 2022.PMID 35065723