1. Toronto, June 6, 2008 Johan Cullberg MD PhD Ersta Sköndal University College, Stockholm

2. 2jc

3. Every first episode psychotic patient from 17 clinics (appr 1.5 million inhabitants) Fullfilling criteria (incl non-congr. aff.ps) (SCID) 253 Incidence/100.000 18-45 years24.5 Dropout (31%) more non-sz78 Research population 175 5-year follow-up 154 Prospective comparison group 3 years 64 Historic comparison group (TAU) 5 years72 jc3

4.  Small scale (3-6 beds)  Non-institutional and personal setting  Non-invasive but empathic and stable staff  No high demands for common activities  Unlocked doors daytime  No chronic patients  Access to emergency ward when needed  Support from mobile psychosis team 4jc

5. Outcome: clinics with crisis home vs. only psychiatric ward Mean GAF- values, schizophrenic syndromes 0 10 20 30 40 50 60 70 Baseline 1 year - p< 0,05 With Crisis home Only ps. ward 5jc

6.  “Recovered”54 %  On antipsychotic med. 48 %  Depot: 3 pats out of 69 4 %  Median dose(halop.eqv) 2 mg  Sick pension or sick leave 32 %  Suicide 1 %  In institution 5 % 6jc

7. 7

8. Outcome level 5 years after first episode psychosis N=153 % 8jc

9.  The 7 ”need specific” principles are feasible and cost-effective with a large scale organisation  Effects better than TAU  There is no rational reason to hesitate in developing specific FEP care in all psychiatric clinics  Psychological and medical treatments must be individualised. There is no general rule how to treat a FEP patient! jc9