Aims of Treatment

Intervention in the acute phase of first-episode psychosis has a number of aims, including those listed in Table 2.5. Although some strategies have immediate or short-term aims, all interventions should help build a foundation for sustained recovery. The fundamental aim of treatment in early psychosis is to assist patients to return to their normal lives as early as possible.

Prevention of future harm is an important aim. Long-term outcomes will be compromised if the young person experiences persistent negative symptoms, persistent positive symptoms, suicidal impulses or substance abuse. It has been suggested that the experience of psychosis is itself ''toxic'' to the brain [34], although this hypothesis has been challenged [35]. Psychological consequences of psychosis include a loss of self-esteem and confidence, developmental stagnation, and secondary disorders such as depression and post-traumatic stress disorder. Social costs of psychosis include disruption of family networks, peer networks, sexual relationships,

Table 2.5 Aims of intervention in first-episode psychosis

Overall aims

• Ensure the safety of the individual and others.

• Reduce symptoms of psychosis and disturbed behaviour.

• Build a sustainable therapeutic relationship with the individual and carers.

• Develop a management plan to aid recovery from the acute episode.

Specific aims

• Monitor the patient's status.

• Minimize trauma.

• Reduce delay in treatment.

• Provide optimal medication to target positive symptoms and disturbed behaviour.

• Prevent or treat negative symptoms and coexisting problems such as depression, mania, anxiety or panic attacks and substance abuse.

• Instil realistic hope.

• Provide an acceptable explanatory model, with education about psychosis and its treatment, including time to recovery.

• Support the family to relieve their distress and improve family functioning.

• Promote adjustment and psychosocial recovery.

• Promote functional recovery.

• Promote continuity of care and adherence to treatment.

• Promote early recognition of further episodes, and identify factors that precipitate or perpetuate episodes.

• Facilitate access to other services in the mental health, general medical and social service systems.

education and vocation, as well as the risks of institutionalization and homelessness [36].

Engagement and collaboration with the patient, family members and other caregivers should begin in the acute phase, as they are often highly motivated to participate in treatment during this time of crisis.

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