Psychological interventions in early psychosis

The effectiveness of psychological treatments in schizophrenia has been explored in controlled trials over the last 15 years leading to the conclusion that they are an important adjunct to antipsychotic medication in the treatment of the disorder. Family interventions and cognitive-behavioral treatments have received the most attention. However, studies have mainly been carried out with individuals with chronic, treatment-resistant psychosis, where participants have already been stabilized on antipsychotic medication, and there has been little evaluation of approaches with people with a first episode of schizophrenia. This article will review the literature relating to cognitive-behavioral individual and family interventions in early psychosis. The little evidence that exists suggests that family interventions and individual cognitive-behavioral interventions are acceptable to first-episode patients and that patients can be retained in treatment. In addition, some studies suggest that psychological treatments convey advantages over standard treatments for psychosis in terms of reducing the transition from pre-psychotic states to full-blown psychosis, reducing residual psychotic symptomatology, and improving caregiver outcomes. Considerable work is needed to elucidate the specific needs of first-episode patients and to rigorously evaluate the effectiveness of psychological interventions. The challenges to be met in developing treatments in this area relate to addressing the developmental needs of this group, incorporating substance use routinely into interventions, and developing treatments that are specific to the phase of illness that the individuals are experiencing.