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Early intervention in psychosis: clinical aspects of treatment

  • Brendan P. Murphy and Warrick J. Brewer

Summary

Engaging patients in first-episode psychosis services is critical in maximising the effect of early intervention and establishing a framework for longer-term treatment. Biopsychosocial assessments determine a working diagnosis and inform evidence-based treatment. Atypical antipsychotics should be used at doses that maximise therapeutic benefit and adherence while minimising side-effects. Patients are helped to construct a narrative of their illness, including a shared understanding of the contribution of biological and environmental risks, and early warning signs. Common comorbid conditions, including depression, suicidal ideation, substance misuse and anxiety, should be addressed. Management of comorbid borderline and antisocial personality disorders is difficult; their nexus with psychosis is discussed. Cognitive–behavioural therapy is a mainstay of treatment, with specific interventions developed for problems typical in first-episode presentations. Core psychosocial interventions include psychoeducation, vocational and educational support, family interventions and multimodal group programmes.

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Copyright

Corresponding author

Associate Professor Brendan P. Murphy, Early in Life Mental Health Service, Community Services Building, 145 Cleeland Street, Dandenong, Victoria, Australia, 3175. Email: brendan.murphy@monash.edu

Footnotes

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For a companion article and related Editorial see pp. 401–7 and 398–400, this issue.

Declaration of Interest

B.P.M. has received research support from Diabetes Australia, the Australian Heart Foundation, Eli Lilly and Sanofi; participated in clinical trials sponsored by Sanofi, Eli Lilly, AstraZeneca, Jannsen-Cilag and Lundbeck; and been a speaker for Bristol-Myers Squibb, Lundbeck and Pfizer. W.J.B. is supported by a National Health and Medical Research Council Career Development Award and the Colonial Foundation, and has received research support from Janssen-Cilag and Eli Lilly.

Footnotes

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Early intervention in psychosis: clinical aspects of treatment

  • Brendan P. Murphy and Warrick J. Brewer
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