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

Abstract

Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.

Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

“…Care staff working in mental health facilities had significantly higher self-efficacy in end-of-life communication compared to care staff working in facilities for older people. This may be due to the experience of mental health staff with psychosocial interventions [42, 43]. Care staff in mental healthcare are also often trained in and accustomed to discussing complex and sensitive topics such as a wish to die [14].…”

Improving access to specialized care for first-episode psychosis: an ecological model

“…Although the evidence suggests that specialized care for FEP has a clear clinical benefit, functional outcomes for many individuals receiving care from these programs remain suboptimal 16. One avenue for optimizing access to care at the organizational level is to increase the initiation of care by creating a “youth-friendly” environment.…”

“…Given strong evidence indicating that longer DUP is associated with negative clinical outcomes and worse response to treatment among individuals with FEP, 10 , 13 , 14 DUP has been identified as an important modifiable risk factor for improving the course of psychotic disorders. 15 , 16 With some notable exceptions, 17 , 18 attempts to reduce DUP and to increase access to specialized care programs for individuals with FEP have been largely unsuccessful. 19 Given the complexity of factors contributing to DUP and the variation of these factors across different healthcare environments, there is likely no singular approach to reducing DUP that can be effectively implemented across settings.…”

“…Although the evidence suggests that specialized care for FEP has a clear clinical benefit, functional outcomes for many individuals receiving care from these programs remain suboptimal. 16 One avenue for optimizing access to care at the organizational level is to increase the initiation of care by creating a “youth-friendly” environment. Recently, additional attention has been given to the creation of mental health services that are sensitive to the developmental and cultural needs of young people in order to improve service utilization.…”

The impact of a transitional intervention for youth living with early psychosis: A mixed methods study

“…The onset of early psychosis in young adulthood can have lifelong consequences for the individual and their family (Breitborde, 2017;Caseiro, et al, 2012). The term early psychosis indicates that the young person is experiencing psychosis for the first time; an illness where individuals lose contact with reality and experience symptoms such as hallucinations, delusions, and social withdrawal (Badcock & Paulik, 2020).…”