Ashok Malla focuses his studies on the early phases of psychotic disorders, such as schizophrenia, and on prevention and early intervention of these severe illnesses. He is an international leader in the development of comprehensive programs for, and research in, early intervention in psychosis.

While, traditionally, the outcome in schizophrenia and related disorders has generally been regarded as poor, there is burgeoning evidence, including work done by Ashok Malla and his group at UWO, that delay in initial treatment of psychosis may be a major contributor to the poor outcome. These findings open a great opportunity for early intervention as a means to improving outcome, while at the same time providing an occasion to investigate the complexity of this relationship. This is particularly relevant from a societal perspective, as the onset of the illness occurs mostly in young people, between the ages of 14-30.

Ashok Malla’s research program involves:

Studies in early stages of psychosis, including:

• Investigation of delay in treatment
• Finding the sources of delay so that interventions directed at improving early case identification can be targeted
• Studying the impact of assertive early case identification on outcome

This work has identified (a) relatively long delays in treatment even after the patient’s first contact with mental health services and (b) that assertive case identification strategies can both reduce delays in treatment as well as bring into treatment individuals who were otherwise not being treated.

Studies examining predictors of outcome on multiple dimensions, including:

• Clinical state and quality of life
• Evaluation of strategies to improve outcome (for example relapse prevention)
• Cognition and psychopathology in early psychosis
• Controlled evaluation of integrated treatment methods

Results thus far indicate that at least 50% of outcome is potentially amenable to impact of better and early treatment and that mental functions such as working memory, non-adherence to treatment, and partial response to treatment are major predictors of outcome in addition to delay in treatment.

This research program aims at extending this work in order to improve knowledge about early signs of psychosis for professionals in the health and educational system, and for the public, as a means to reducing delays in treatment. In addition, this program will start examining the period immediately before onset of psychosis in individuals at high risk with a view to eventually developing treatment for this phase of the illness, so that psychosis can be prevented.