Early intervention in psychosis

Psychosis is a mental health condition that is characterized by the presence of symptoms such as hallucinations, delusions, and changes in thoughts and behaviors. Receiving appropriate professional treatment in a timely manner can help to reduce and manage these symptoms, potentially preventing the development of severe psychotic disorders.

What is early intervention in psychosis?

Early intervention in psychosis (EIP) refers to a service provided by a multidisciplinary team to people who are at a high risk of experiencing psychosis. The aim of EIP services is to recognize and provide support and treatment to these individuals in the shortest possible time frame, in order to improve recovery and prevent relapse.

EIP services offer rapid access to and delivery of specialized support and treatment to high-risk individuals or those experiencing their first episode of psychosis. EIP aims to be preventative rather than reactive. The aim is to begin delivering this service within the first few weeks of psychosis, to limit the potential impact of psychosis or psychotic disorders ^[1][2].

A multidisciplinary team, which may include psychiatrists, clinical psychologists, and occupational therapists, will provide treatment and support to the individual and their family members or caregivers over a period of several years. The intention of treatment is to prevent the development of a severe illness through the implementation and continuation of psychosocial support, psychological intervention, and medication ^[3][4].

How do early intervention in psychosis services work?

Referral and assessment

When presenting with a first episode of psychosis or high-risk behaviors and symptoms, such as delusions or hallucinations, individuals will be referred to an early intervention service, where they will be assessed by a mental health professional.

The assessment will likely involve gathering information about the individual’s current mental state and symptoms, their past mental and physical health history, family history of mental health, and any risks to themselves or others.

This will enable the professional to determine if the individual is demonstrating clear warning signs that they are at high risk of experiencing a psychotic episode, known as a high-risk mental state. The assessment can also help determine if the individual is currently experiencing a first episode of psychosis ^[5].

If EIP services are required, they will be implemented within a short time frame. The aim is to commence treatment within the first few weeks of symptom presentation. EIP services will likely continue for several years, usually between 2-5 years, to provide the continuation of effective medicinal and psychosocial interventions to ensure positive recovery outcomes ^[2][6].

EIP services typically involve the input of a multidisciplinary team, including a psychiatrist, psychologist, mental health nurse, occupational therapist, and medical physician, with links to other agencies and specialist services ^[3].

Medication

To stabilize the individual’s mental state, it is likely that they will be prescribed medication. Studies suggest that atypical antipsychotics (also known as second generation antipsychotics) prescribed at a low dose can be effective at managing symptoms during the first episode of psychosis ^[2][5].

This may vary depending on the individual, their age, physical health, and response to the medication, and will involve careful monitoring, with changes if required ^[3].

Psychological intervention

Individuals will be offered a therapeutic intervention, such as cognitive behavioral therapy (CBT), other types of individual or group psychotherapy, or family therapy. This has been shown to help with reducing symptoms and emotional distress by providing support and understanding of the condition and teaching positive coping strategies ^[2][5].

Family and carer intervention

Family members and caregivers will be offered support and education around the condition and treatment of the individual. Family and carer input is crucial in the treatment process. It can help to improve recovery outcomes and reduce the need for hospitalization, as well as help to improve the individual’s environment and lifestyle choices.

Furthermore, family members and caregivers are provided with support to manage their own mental wellbeing throughout their loved one’s recovery process. Support can help caregivers manage any added challenges or emotional distress they may experience as a result of their loved one’s struggle ^[3][5].

Physical health

The individual will have physical health assessments to monitor their response to medication. Physical health assessments will build understanding and promotion of a healthy diet and exercise while also providing support in reducing smoking or alcohol and substance use.

Physical health complications are common within the context of psychotic disorders. Therefore, monitoring and maintaining the individual’s physical health throughout recovery is of great importance. Positive physical health habits can improve an individual’s quality of life, and reduce the likelihood of serious medical issues, such as cancer, diabetes, and addictions ^[3][5].

Social support

EIP also offers support in finding and receiving education and employment, such as helping individuals to take part in employment programs and skills training. Depending on the individual’s needs, Professionals can also provide support in managing housing concerns, social and community engagement, and financial matters ^[3][6].

Crisis and relapse planning

Although the aim of early intervention services is to prevent relapse or worsening mental health, there is a risk of this occurring. As such, support is put in place to help individuals recognize relapse symptoms, develop a plan of how to manage symptoms, and decide who to contact should this occur ^[5].

Benefits of early intervention in psychosis

Improved mental health

Early intervention has been shown to improve outcomes for those with first episode psychosis. It can reduce the risk of relapse, prevent worsening mental health, prevent the need for hospitalization, reduce the risk of suicide, and improve the management of symptoms of psychosis. All of these benefits, help to prevent the development of more severe psychotic disorders ^[3][6].

By receiving immediate appropriate treatment, the overall safety and wellbeing of these individuals is greatly improved. With EIP, symptoms are being managed and treated before they become severe, which also reduces the impact on family members or carers ^[2][7].

Similarly, those in a high-risk mental state can be treated prior to the development of psychosis, helping to prevent or delay the onset of a psychotic disorder ^[2][5].

Psychosis can occur in the context of several conditions, including schizophrenia, bipolar disorder, and personality disorders. Psychosis can also be drug induced. It is common for it to take several months for a proper diagnosis to be reached, but, with EIP services, waiting for a diagnosis is no longer a barrier to receiving treatment ^[3].

This rapid access to treatment also allows for the fast recognition and treatment of other mental health conditions, such as depression, anxiety, substance misuse, and trauma, which commonly occur alongside psychosis ^[3][5].

By providing care in the earlier stages of psychosis, individuals are more likely to continue engaging with services, comply with prescribed medications, and develop trusting therapeutic relationships with professionals. These benefits thereby contribute to more positive outcomes in the recovery process ^[2][5].

Improved physical health

Physical health issues are common in psychosis and psychotic disorders, causing a significantly reduced life expectancy in this group when compared to the general population. This is often due to issues such as weight gain caused by medication, poor diet, inactivity, diabetes, substance and alcohol use, smoking, and poor dental health ^[7].

By implementing early intervention, those who would be at a high risk of developing these physical health complications can be provided with better education and support around their physical health and lifestyle choices ^[4][6].

Improved social functioning

People with untreated or prolonged psychosis are more likely to experience social withdrawal, housing issues, unemployment, and financial difficulties. These issues commonly become more severe the longer the duration of the illness, particularly in individuals who do not have access to professional services ^[3].

With early intervention services, professionals offer social functioning support, thereby improving their quality of life and financial stability ^[1][6].

Reduced costs

Psychotic disorders contribute greatly to healthcare and governmental costs, incurred due to hospitalization, demand on other mental health services, requirements for physical health treatment, and lack of employment ^[1].

By providing early intervention, mental health treatment costs can be greatly reduced, which, in turn, reduces other economic impacts that often occur alongside severe mental illness ^[2][6].