What is the First Episode of Psychosis?
Psychosis is a mental health condition where you lose touch with reality, which can include hallucinations, delusions and disorganized thinking. Symptoms usually emerge between 16-30 years old. Unfortunately, many people don’t get treatment until 74 weeks – over a year – after symptoms start, which can impact long-term recovery.
What is First-Episode Psychosis (FEP)?
First-Episode Psychosis (FEP) is the first time you experience psychotic symptoms. These symptoms can be linked to various mental health conditions such as schizophrenia, schizoaffective disorder or bipolar disorder with psychotic features.
Symptoms of Psychosis
- Delusions: Beliefs that aren’t based on reality (e.g., being followed).
- Hallucinations: Hearing or seeing things that aren’t there.
- Disorganized Thinking: Trouble putting thoughts together or making sense of them.
- Loss of Contact with Reality: Feeling disconnected from the world.
Early intervention and treatment of FEP is key as it impacts long-term outcomes and quality of life.
Benefits of Early Intervention in First-Episode Psychosis
Less Hospitalisation
Early intervention aims to get treatment quickly to manage symptoms and often prevents the need for long hospitalization. Research shows that people who get treatment in the first 2 years of symptoms are less likely to be hospitalized. If hospitalization is needed, their stays are shorter. Early intervention services offer community-based treatment so people can stay at home and keep their daily routines and minimize disruption to their lives.
For example, Paula a 19 year old college student having her first psychotic episode received immediate intervention through a community program. This support allowed her to manage her symptoms without hospitalization and continue her studies.
Better Functioning
By getting symptoms stabilized early, people are more likely to get back to their previous levels of functioning. Early intervention allows them to continue with their work, education and social activities. Maintaining these roles is a big part of recovery as it promotes independence and prevents long-term disability and social isolation.
John started to show symptoms of psychosis at 22. Early intervention allowed him to keep his job and his friends, which was key to his self-esteem and recovery.
Less Chance of Relapse
Relapse is a big concern in psychotic disorders. Early intervention programs are designed to reduce this risk by combining medication management, psychoeducation and family therapy. These programs teach individuals and their families coping skills so treatment adherence is better. Research has shown early intervention can reduce relapse rates by up to 50% compared to standard treatment (Marshall et al., 2021).
Better Recovery Outcomes
Recovery means symptom management, functional improvement, and a better quality of life overall. Early engagement in treatment is key to significant symptom reduction. Early intervention programs involve multidisciplinary teams working with individuals to develop personal recovery plans that include not just symptom control but also social and professional goals.
Early Care Steps That Matter
Your Health Check
When you start your journey towards mental wellness, the first thing you need is a clear picture of what’s going on. It’s like putting together a jigsaw puzzle – we gather information about symptoms and look into family history and medical background. This helps us see the bigger picture.
The initial assessment usually includes:
- Brain imaging tests like MRI or CT scans (I know they sound scary but they’re actually quite normal!)
- Some psychological assessments (think of them as conversations with a purpose)
- Conversations with mental health professionals who really get you
Finding Your Medicine Balance
When it comes to medication, especially antipsychotics, it’s not about taking the most amount possible. It’s about finding that sweet spot – enough to help you feel better but not so much that side effects become too much. It’s like finding the right temperature for a shower – not too hot, not too cold, but just right.
Your Journey
Cognitive-behavioral therapy (CBT) has proven to be really effective in helping people manage their symptoms. Through CBT you learn practical skills to deal with difficult thoughts and feelings. It’s like building your own personal toolkit for wellness. And you’re not alone in this – whether group sessions or family therapy, there’s always someone with you.
Social Rehabilitation
Early intervention may include:
- Social Skills Training: It helps to improve communication and social interactions.
- Vocational Support: It helps in job training and employment.
- Educational Assistance: Providing resources to continue or resume education.
The aim is to get people back into society and independent. Programs often provide practical help with housing and daily living skills to reduce stress and speed up recovery.
Family Support
Family involvement is key. Family-focused interventions educate relatives about the condition so they can provide a supportive environment without putting pressure on the person. Research shows family therapy is linked to better outcomes and lower relapse rates (Dixon et al., 2017)
For instance, a family participating in therapy sessions learns how to communicate effectively and recognize early warning signs of relapse, creating a stronger support system for their loved one.
First Episode Psychosis Challenges
Early Identification
Identifying the early signs of psychosis can be tricky. Symptoms can be subtle and mistaken for stress, substance use or other mental health issues. Some people may not seek help because they don’t know or are in denial about how bad their symptoms are.
Solution: Public awareness campaigns can educate people about the signs of psychosis and encourage earlier help-seeking.
Access to Care
Location and availability of specialist services can limit access to early intervention programs, especially in rural or hard-to-reach areas.
Solution: Expand telepsychiatry and increase funding for mental health services in underserved areas.
Stigma
The stigma around mental illness can stop people and families from seeking help because of fear of being judged or discriminated against.
Solution: Anti-stigma campaigns and community outreach can educate the public, dispel myths and promote a more accepting attitude to mental health.
Conclusion
Investing in early intervention for first-episode psychosis is good for individuals and cost-effective for the health system. Early treatment means better recovery outcomes, less relapse and people can live fulfilling productive lives.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- McGorry, P. D., et al. (2018). Early Intervention in Psychosis: Concepts, Evidence, and Future Directions. World Psychiatry, 17(3), 327–338.
- Breitborde, N. J. K., et al. (2019). Optimizing Outcomes in First-Episode Psychosis: Advances in Early Intervention and Treatment. Psychiatric Times, 36(8), 12–15.
- Birchwood, M., et al. (2017). The Critical Period Hypothesis and the Importance of Early Intervention in Psychosis. The British Journal of Psychiatry, 211(6), 327–333.
- Addington, D., et al. (2019). A Systematic Review of Interventions to Support the Role of Families in the Recovery of Individuals with First-Episode Psychosis. Schizophrenia Bulletin, 45(1), 51–62.
- Penn, D. L., et al. (2020). The Effectiveness of Early Intervention Programs for Psychosis: A Meta-Analysis. Schizophrenia Research, 224, 3–12.
- Marshall, M., et al. (2021). The Reduced Risk of Relapse with Early Intervention in Psychosis Programs: A Systematic Review. The Lancet Psychiatry, 8(11), 1067–1077.
- Correll, C. U., et al. (2020). Comparing First-Episode and Chronic Schizophrenia Patients: Outcome Results Over Time. American Journal of Psychiatry, 177(4), 274–284.
- McClellan, J., & Keshavan, M. R. (2018). First-Episode Psychosis: Assessment and Diagnosis. JAMA Psychiatry, 75(2), 113–114.
- Kane, J. M., et al. (2019). Guidelines for the Management of First-Episode Psychosis. Journal of Clinical Psychiatry, 80(2), 18nr12356.
- Morrison, A. P., et al. (2018). Cognitive Therapy for Psychosis: Results from a Randomized Controlled Trial Schizophrenia Bulletin, 44(3), 725–733.
- Bond, G. R., et al. (2019). Supported Employment for People with Severe Mental Illness: A Review of the Literature. Journal of Vocational Rehabilitation, 51(2), 215–226.
- Dixon, L., et al. (2017). Family Interventions in Early Psychosis: Clinical and Cost Effectiveness. American Journal of Psychiatry, 174(5), 425–433.
- Mueser, K. T., et al. (2018). Delays in Treatment Seeking for First-Episode Psychosis: A Systematic Review. Psychological Medicine, 48(9), 1297–1307.
- Killackey, E., et al. (2020). Geographic Disparities in Access to Early Intervention Services for Psychosis. Social Psychiatry and Psychiatric Epidemiology, 55(10), 1381–1391.
- Corrigan, P. W., et al. (2018). The Impact of Stigma on Help-Seeking and Treatment Outcomes in Early Psychosis. World Psychiatry, 17(1), 28–40.
- Rabinowitz, J., et al. (2021). Future Directions in Research on Early Intervention in Psychosis. Schizophrenia Research, 227, 1–4.
Authored By
Shebna N Osanmoh I, PMHNP-BC
Nov 07, 2024
Shebna N Osanmoh is a board-certified Psychiatric Mental Health Nurse
Practitioner with extensive experience across the mental health spectrum. Holding a Master’s in
Psychiatric/Mental Health Nursing from Walden University, Shebna provides compassionate,
culturally sensitive care for a wide range of mental health conditions, emphasizing holistic and
individualized treatment approaches to support patients in their wellness journey.