Challenges

Challenges for clinicians include the need to reduce the trauma associated with early psychosis and its treatment, while ensuring the safety of the patient and others. Management strategies should be broad in their

Early Detection and Management of Mental Disorders.

Edited by Mario Maj, Juan Jose? Lopez-Ibor, Norman Sartorius, Mitsumoto Sato and Ahmed Okasha. ©2005 John Wiley & Sons Ltd. ISBN 0-470-01083-5.

approach, addressing not just the biological aspects of the illness but also the psychological and social components. Approaches to treatment should be flexible, so they can adapt to the diagnostic uncertainty that often characterizes early psychosis and recognize that the challenging behaviours of normal adolescence can accompany the abnormal behaviours resulting from the illness. Clinicians and the mental health system should be able to quickly address the specific needs of the patient and family, rather than applying a standard and inflexible model of care [3].

Failures in the care of young people with early psychosis have included:

• prolonged delays in accessing effective treatment, which all too often begins at a time of a severe crisis [4,5];

• provision of initial treatment which is traumatic and alienating [6];

• poor continuity of care;

• poor engagement of the patient in treatment [1]. Special Features of Early Psychosis

Some differences between individuals with early psychosis and those with chronic psychotic illness are summarized in Table 2.1.

Table 2.1 Special features of early psychosis

Compared to people with a chronic psychotic illness, those with early psychosis tend to be:

• less informed about mental illness

• agitated or distressed by unfamiliar symptoms which can be frightening or bewildering

• unaware of mental health services that are available, and how they operate

• more likely to deny the existence of an illness and to have a sense of invulnerability

• exhibiting normal adolescent behaviours which can mask symptoms

• experiencing an illness which is still "evolving", making diagnosis more difficult

• uncertain about, or afraid of, treatment including medication and hospital admission

• not previously exposed to psychotropic medication and more susceptible to side effects.

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