Early intervention in psychosis: first-episode psychosis and critical period.

Ricardo Coentre, Pedro Levy, Maria Luísa Figueira

Abstract


Besides intervention in prepsychotic period, early intervention in psychosis includes interventions done after the onset of the first-episode psychosis, namely psychopharmacological and psychosocial phase-specific intervention. The main aim is to reduce the duration of untreated psychosis (DUP) and to ensure that besides remission of the symptoms there is also a psychosocial recovery. Many centers set up an assertive and integrated early intervention program, involving an active search of patients with a treatment that includes antipsychotic medication, cognitive behavioral therapy, psychoeducation, family and vocational interventions. The authors of this review explain the concepts and main studies that support this kind of treatment in early psychosis. The results of published data show that is possible to reduce the DUP and improve the clinical and functional outcomes with this intervention. Critical period hypothesis proposes that deterioration occurs aggressively in the first 2 to 5 years of early psychosis, so it is crucial to intervene in this period to ensure a functional recovery. Cost-benefit ratio seems to be favorable to early intervention model, with reduction of in-stay period, which is an important component of the direct costs of psychotic illness. Early intervention service model organization is also reviewed by the authors of this research. The results of many studies show favorable outcomes for the integrative early intervention and so many countries included it in their political mental health directives and attributed funds for early intervention in psychosis.

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