The onset of psychotic illnesses occurs most commonly in late adolescence or early adulthood. The emergence of the illness via a prodrome with the later advent of acute psychotic symptoms is typically an extremely disturbing experience for a young person, their family and friends, leading to a highly emotional and volatile environment. The way that a psychotic illness is first managed provides an opportunity to reduce the immediate and future harm associated with it, and to establish a positive basis for future care. This simple principle has been embraced in an increasing number of centres around the world and underpins the widespread reform process now under way [1].

High quality care has the potential to provide special benefits in young people with early psychosis. Late adolescence and early adulthood is a critical stage of psychological, social, educational and vocational development. Serious mental illness can cause very substantial disruption to these processes, leading to long-term functional disability and poor outcomes. Effective intervention in the initial phases of psychosis can help prevent the biological, psychological and social deterioration that can occur in the early years [2]. This chapter focuses particularly on the optimal care of the prepsychotic phase and the first episode of psychosis.

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