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First Episode Psychosis

Recovery After an Initial Schizophrenia Episode (RAISE)

Early, or a first episode psychosis, are the first signs that a person is experiencing a loss of contact from reality. This moment is often frightening, confusing and distressing to a person and his or her family. Psychosis is a symptom, not an illness. Episodes of psychosis can be related to schizophrenia, bipolar disorder or post-traumatic stress disorder.  Psychosis can also be the result of physical illness, substance use, trauma or extreme stress.

Approximately 3 in 100 people will experience an episode of psychosis during their lives. Young adults are placed at an increased risk because of hormonal changes in the brain that occur during puberty, but a psychotic episode can occur at any age.

What are the Warning Signs?

Most people think of psychosis as a sudden break from reality, but there are often warning signs that precede an early episode of psychosis. Knowing what to look for provides the best opportunity for early intervention. Some signs include:

  • A worrisome drop in grades or job performance
  • Trouble thinking clearly or concentrating
  • Becoming suspicious or uneasy around others
  • A decline in self-care or personal hygiene
  • Spending a lot more time alone than usual
  • Strong, inappropriate emotions or having no feelings at all

Receiving a Diagnosis

A diagnosis identifies an illness, and symptoms are components of an illness. Health care providers draw on information from medical and family history along with a physical examination to make a diagnosis. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the cause.

Treatment and Support

Identifying and treating psychosis early leads to the best outcomes. Early intervention is always the best approach for mental health conditions, because it offers the chance to prevent the condition from progressing. The most effective way to address early and first episode psychosis is with a coordinated array of specialty care.

Coordinated Specialty Care

Coordinated specialty care programs use a team-based approach and shared decision making with youth and young adults with a focus on their recovery goals. The coordinated array of specialty care provided in early and first episode psychosis programs include:

  • Community outreach and engagement so that program specialists can reach youth, families, schools and others to identify youth and young adults who may be experiencing early psychosis.
  • Family support and education because families play an important role in recovery. This helps families learn about psychosis, learn new problem solving skills and learn from each other. Families support their loved ones to stay engaged in services and supports and are key members of the care team.
  • Peer support, which provides youth a vital connection to other youth who have been through similar experiences and can speak from a place of understanding.
  • Supported education and employment, which helps youth and young adults continue in or return to work and school and provides support, so that they may reach their work and educational goals.
  • Case management with clinicians working with youth in problem solving, managing medication and coordinating services
  • Psychotherapy that emphasizes resiliency, illness and wellness management and coping skills.
  • Medication management that focuses on providing the lowest dose of medication as possible.

How do I access these services and supports?

There are a growing number of early and first episode psychosis programs around the country. Here are links to programs that offer coordinated specialty care and helpful resources and information for youth, young adults and families:

What do I do if there are no early or first episode psychosis programs nearby?

If there is not a program close by, then contact a university close by with a medical school. The medical school will most likely have access to information on the latest research. If you are not close to a university, then schedule an appointment with a qualified psychiatrist who has experience treating psychosis.

Before the appointment, do your homework. Become familiar with the coordinated array of specialty care delivered in early and first episode psychosis programs. If the psychiatrist confirms that you are experiencing early psychosis, ask if the psychiatrist is familiar with the latest research in treating early psychosis. Don’t be afraid to print out material from the National Institute of Mental Health (NIMH), NAMI’s website or from program websites that identify the coordinated array of specialty care.

Let the psychiatrist know that the manuals and material used in research supported by NIMH on early and first episode psychosis are available. You may wish to identify the components of the variety of specialty care and ask that they be included in your care plan.

Ask the psychiatrist if he or she would be open to having you share information about the research-based approaches to early and first episode psychosis. If so, then share resources from NIMH and/or suggest that the psychiatrist contact existing program sites to learn more.

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