Evidence-based psychotherapy for the prevention and treatment of first-episode psychosis

The aim of psychotherapy among individuals at clinical high risk (CHR) for psychosis is to prevent transition to full-blown psychosis. Psychotherapy in individuals with a first-episode psychosis (FEP) aims to reduce relapse rates. Remission of (pre-) psychotic symptoms, psychosocial functioning, quality of life, comorbid disorders and self-esteem are also important outcomes in individuals at CHR and with FEP. Antipsychotics, Qmega-3-Fatty acids and psychotherapy have been found to be effective in CHR for most of these aims. Thereby psychotherapy presents a better benefit/risk ratio than antipsychotic medication. The most evidence-based intervention is cognitive-behavioral therapy (CBT). Psychotherapy is mostly offered to FEP patients within specialized early intervention services (including assertiveness community treatment and antipsychotic medication). Thereby, CBT is effective for positive symptoms and family intervention is particularly effective for the prevention of relapses. We introduce the principles of CBT for psychosis and suggest adaptions for individuals at CHR and FEP. We conclude that the needs of young people at CHR and with FEP are best met by specially designed, low threshold outpatient clinical services, which include intensive psychotherapy treatment. A number of countries have implemented early detection and intervention services based on this model, while the implementation within in Germany is still marginal

What to do before it starts? FRITZ - The early intervention and therapy centre in Berlin

First episode psychosis frequently manifest in young adulthood and can impact severely on the lives of the affected individuals and their relatives. In most cases, a first episode psychosis is preceded by a long-term prodromal phase with heterogeneous symptomatology and considerable functional impairment. The early identification of individuals at high risk of psychosis enables a timely implementation of preventive strategies, and an early diagnosis and the start of an adequate therapy, including pharmacological, psychotherapeutic and socio-therapeutic approaches, are essential for the prognosis of the disease. These aims are best achieved in specialised early intervention centres for young people experiencing first-episode psychosis. While in many countries such centres form part of standard care provisions, in German-speaking areas they remain the exception. The Early Intervention and Therapy Centre FRITZ am Urban offers in-and out-patient care for persons at risk of psychosis as well as for individuals in an early phase of the disease. Low-threshold counselling, an open and supportive attitude on the part of the multidisciplinary team, the availability of regular contact persons, the preservation of patient autonomy, the strengthening of a patient's self-esteem and peer consultation and peer support are designed to create a positive first contact experience with the psychiatric care system. The treatment on offer is of a pronounced psychotherapeutic orientation, and an early application of Individual Placement and Support (IPS) strategies not only seeks to reduce symptoms but also to contribute to functional recovery