Psychological Interventions in First Episode Psychosis

Psychological interventions can help to reduce the severity of acute psychotic symptoms [12]. Patients generally require an environment which provides low stimulation and high levels of support. Empathy and concern for the distress of the patient and family is essential, even though interaction with a floridly psychotic person might be difficult.

Table 2.13 Reasons for psychological interventions in early psychosis

• To develop a therapeutic alliance

• To promote adherence to medication

• To provide emotional support in the face of disturbing subjective experiences and stigma

• To specifically target individual symptom complexes, comorbidities and maladaptive schemas

• To reduce treatment resistance

• To enhance coping and adaptation

• To improve cognitive functioning

• To improve interpersonal relationships, which may be independently problematic or have been disrupted by illness

• To promote vocational recovery

• To provide support and care to family members including siblings

• To reduce risks of suicide and aggression

• To prevent relapse

Psychological interventions are essential for many reasons in early psychosis [67] (Table 2.13).

In the acute phase, cognitive strategies can be brought into play quite rapidly to:

• facilitate discussion about distressing symptoms;

• obliquely challenge patients' thoughts and assumptions about themselves and the future;

• enhance self-esteem;

• facilitate discussion about stigma.

Individual interventions based on cognitive-behavioural approaches can hasten and consolidate the resolution of psychotic symptoms [68]. They assist patients to recognize their symptoms, label them appropriately, deal with secondary affective features, and use various distraction or desensitization techniques. More specific targeting of delusional beliefs and hallucinations may also help attenuate these features before they become too deeply entrenched. The second to fourth week of medication is probably a crucial time for introducing cognitive-behavioural techniques which ''challenge'' the patient's delusions and hallucinations, as it is at this stage that most patients start to develop some insight into their psychotic experiences. Cognitively oriented therapies can also help to facilitate recovery over the subsequent 6-12 months of care [69] as well as focusing on specific clinical foci such as suicide risk and persistent positive symptoms [70,71].

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