Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions

Abstract

Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.

Keywords:

• first-episode psychosis
• multicomponent care
• psychosocial treatment
• personal-ized medicine

Disclosure

Drs Breitborde and Moe have both received salary support from the Institute for Mental Health Research (IMHR) to support the launch of IMHR’s new clinical service for individuals with first-episode psychosis. They also received salary support from the Ohio Department of Mental Health and Addiction Services to support the launch of a new clinical service for individuals with first-episode psychosis in Fairfield County, Ohio. This project was supported by funds provided by The Ohio State University Department of Psychiatry and Mental Health to Dr Breitborde. The authors report no other conflicts of interest in this work.