Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions

Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment.

Download Full-text

Service Engagement in First-Episode Psychosis: Current Issues and Future Directions

The Canadian Journal of Psychiatry ◽

10.1177/070674371506000802 ◽

2015 ◽

Vol 60 (8) ◽

pp. 341-345 ◽

Cited By ~ 42

Author(s):

Shalini Lal ◽

Ashok Malla

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Future Directions ◽

Episode Psychosis ◽

Service Engagement

Download Full-text

Developing early intervention services in the NHS: a survey to guide workforce and training needs

Psychiatric Bulletin ◽

10.1017/s0955603600002531 ◽

2003 ◽

Vol 27 (07) ◽

pp. 254-258 ◽

Cited By ~ 12

Author(s):

Swaran Singh ◽

Christine Wright ◽

Eileen Joyce ◽

Tom Barnes ◽

Thomas Burns

Keyword(s):

Early Intervention ◽

Psychosocial Interventions ◽

Behavioural Therapy ◽

First Episode Psychosis ◽

First Episode ◽

Care Programme ◽

Early Intervention Services ◽

Episode Psychosis ◽

Trained Staff ◽

Intervention Services

Aims and Method We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London. Results All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis. Clinical Implications Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

Download Full-text

Multielement psychosocial interventions for first-episode psychosis are feasible and show promise in generic mental health services

Evidence-Based Mental Health ◽

10.1136/eb-2015-102178 ◽

2015 ◽

Vol 18 (4) ◽

pp. 127-127 ◽

Cited By ~ 1

Author(s):

Mario Alvarez-Jimenez ◽

John F Gleeson

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Psychosocial Interventions ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis

Download Full-text

Response to ‘Diagnostic uncertainty, antipsychotic dosing, and optimal psychosocial interventions: Unanswered questions in first-episode psychosis’

Schizophrenia Research ◽

10.1016/j.schres.2021.02.004 ◽

2021 ◽

Vol 231 ◽

pp. 1-2

Author(s):

Brian O'Donoghue ◽

Barnaby Nelson ◽

Shona Francey ◽

Patrick McGorry

Keyword(s):

Psychosocial Interventions ◽

First Episode Psychosis ◽

First Episode ◽

Diagnostic Uncertainty ◽

Episode Psychosis

Download Full-text

Analysis of the initial treatment phase in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/s0007125000297699 ◽

1998 ◽

Vol 172 (S33) ◽

pp. 71-76 ◽

Cited By ~ 57

Author(s):

Paddy Power ◽

Kathryn Elkins ◽

Steven Adlard ◽

Christina Curry ◽

Patrick McGorry ◽

...

Keyword(s):

Low Dose ◽

Rating Scale ◽

Treatment Phase ◽

Psychosocial Interventions ◽

First Episode Psychosis ◽

First Episode ◽

The People ◽

Episode Psychosis ◽

Scale Scores ◽

Psychiatric Rating Scale

Background The Early Psychosis Prevention and Intervention Centre (EPPIC) commenced operation in Melbourne, Australia, in 1992. It offers a model for management of first-episode psychosis, utilising principles of early detection, low-dose medication and comprehensive psychosocial interventions within the least restrictive setting.Method Data were examined from the first three months of treatment for all consecutive people with first-episode psychosis (n=231) accepted in the programme in 1995–1996. A subsample of patients (n=120) was assessed comparing clinical ratings with variables of gender, diagnosis, hospitalisation, and medication.Results Hospitalisations were brief, and avoided for a third of the people. Low-dose antipsychotic medication was maintained in both in-patient and community settings. Those people with manic psychosis were more likely to be hospitalised. Hospitalised people received higher antipsychotic dosages, and had a greater rate of reduction in Brief Psychiatric Rating Scale psychotic sub-scale scores at three months follow-up. Eighty per cent of a representative subsample had responded to treatment and 63% were in remission by the end of the three months.Conclusion This naturalistic study suggests that the feasibility of implementing the EPPIC model in a range of clinical settings is promising and applicable in practice.

Download Full-text

Diagnostic uncertainty, antipsychotic dosing, and optimal psychosocial interventions: Unanswered questions in first-episode psychosis

Schizophrenia Research ◽

10.1016/j.schres.2020.11.042 ◽

2020 ◽

Author(s):

Joseph M. Pierre

Keyword(s):

Psychosocial Interventions ◽

First Episode Psychosis ◽

First Episode ◽

Diagnostic Uncertainty ◽

Episode Psychosis

Download Full-text

Developing early intervention services in the NHS: a survey to guide workforce and training needs

Psychiatric Bulletin ◽

10.1192/pb.27.7.254 ◽

2003 ◽

Vol 27 (7) ◽

pp. 254-258 ◽

Cited By ~ 9

Author(s):

Swaran Singh ◽

Christine Wright ◽

Eileen Joyce ◽

Tom Barnes ◽

Thomas Burns

Keyword(s):

Early Intervention ◽

Psychosocial Interventions ◽

Behavioural Therapy ◽

First Episode Psychosis ◽

First Episode ◽

Care Programme ◽

Early Intervention Services ◽

Episode Psychosis ◽

Trained Staff ◽

Intervention Services

Aims and MethodWe conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.ResultsAll 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis.Clinical ImplicationsEstablishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

Download Full-text