Modern Approaches To Treatment

The central message of the early intervention paradigm is clearly reflected in the very first guideline statement in the National Institute for Clinical Excellence (NICE) document: ''Health professionals should work in partnership with service users and carers offering help, treatment and care in an atmosphere of hope and optimism'' [14]. Realistic hope and optimism are key ingredients in the management of all potentially serious conditions and should be valued therapeutically. This represents a significant shift in the care of psychoses in general and schizophrenia in particular and should be extended to all phases of illness [15].

Modern approaches to the treatment of early psychosis also reflect the following issues:

• It is often difficult to make a precise diagnosis in patients with a first episode of psychosis. When an initial diagnosis is made, it will often be modified as time passes and more information becomes available [9].

• The early course of illness is a dynamic process, reflecting interactions between the vulnerability of individuals and the stressors that are present in their environments.

• The long-term outcome after a first episode of psychosis is variable, but recovery from acute symptoms should be expected.

• There is scope to apply a preventive model, to reduce the recurrence and/or severity of future psychotic illness.

• Optimal treatment for young people with early psychosis may differ markedly from that for older people with chronic psychotic illnesses, as discussed above.

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