Principles of Intervention
The early diagnosis and treatment of first episode psychosis can significantly improve the prospect of recovery and reduce longer-term impairment for many individuals.
However, diagnosis can be difficult, not least as first-episode psychosis can present in a number of different ways. In addition, because many health professionals who do not specialise in psychosis may only see one or two people with a developing psychosis each year, this diagnosis may not be foremost in their mind. It is therefore imperative to maintain an index of suspicion, and to consider an emerging psychotic illness as a differential diagnosis for any young person that presents with significant changes in functioning, behaviour, or personality, particularly if other risk factors, such as a family history of mental health difficulties, are present. EPPIC has developed a specialised manual to assist GPs in the identification and treatment of people with early psychosis. Click here to obtain a PDF of the GP Manual.
Workers in settings such as schools and youth counselling should include secondary consultation with a Youth Early Psychosis Service (YEPS) or other specialised tertiary service. The mental health team of a local hospital should be able to offer advice fo the the best service to contact. Click here for list of local services.
Early intervention can occur in four main stages. These are:
- Detection and assessment
- Immediate management/treatment
- Early and Late recovery
- Continuing care
Detection and assessment includes considering that psychosis might be a possibility, focusing on the importance of engaging the young person in the assessment process.
Immediate management and treatment often requires the integrated use of pharmacological, psychological, family and social interventions.
Recovery is the norm after an initial psychotic episode and around 25% of affected young people will never experience a further psychotic episode. Others remain vulnerable to future exacerbations of their psychotic disorder, or may neen more intensive work to assist their recovery.
The major aim after achieving remission is therefore to promote wellness and prevent relapse. Continuing care is far from a passive process and requires a structure and purpose for each encounter.
The issues for the person and therefore the treatment focus, will differ depending on the particular phase. In addition, issues relating to symptoms are also intimately intertwined with the normal developmental tasks of adolescence including the attainment of a stable sense of identity, a move towards adult independence, decisions regarding study and work decisions and the building of friendships and intimate relationships. These developmental tasks form the background against which all treatment needs to be framed.
At each stage, a respectful and collaborative therapeutic relationship is required and key principles include:
- Providing necessary education, offering support, and attaining a shared explanatory model and intervention plan with the young person and their family
- Combined pharmacological, psychological, family and social interventions, which focus on managing triggers and promoting resilience