Early Interventions for Psychosis

Morris B. Goldman, MD; Marko Mihailovic, MA, LCPC; Philip G. Janicak, MD


Curr Psychiatr. 2021;20(10):13, 24-31. 

In This Article


Neuroscience research over the past half century has failed to significantly advance the treatment of severe mental illness.[1,2] Hence, evidence that a longer duration of untreated psychosis (DUP) aggravates—and early intervention with medication and social supports ameliorates—the long-term adverse consequences of psychotic disorders generated a great deal of interest.[3,4] This knowledge led to the development of diverse early intervention services worldwide aimed at this putative “critical window.” It raised the possibility that appropriate interventions could prevent the long-term disability that makes chronic psychosis one of the most debilitating disorders.[5,6] However, even beyond the varied cultural and economic confounds, it is difficult to assess, compare, and optimize program effectiveness.[7] Obstacles include paucity of sufficiently powered, well-designed randomized controlled trials (RCTs), the absence of diagnostic biomarkers or other prognostic indicators to better account for the inherent heterogeneity in the population and associated outcomes, and the absence of modifiable risk factors that can guide interventions and provide intermediate outcomes.[4,8,9,10]

To better appreciate these issues, it is important to distinguish whether a program is designed to prevent psychosis, or to mitigate the effects of psychosis. Two models include the:

  • Prevention model, which focuses on young individuals who are not yet overtly psychotic but at high risk

  • First-episode recovery model, which focuses on those who have experienced a first episode of psychosis (FEP) but have not yet developed a chronic disorder.

Both models share long-term goals and are hampered by many of the same issues summarized above. They both deviate markedly from the standard medical model by including psychosocial services designed to promote restoration of a self-defined trajectory to greater independence.[11,12,13,14] The 2 differ, however, in the challenges they must overcome to produce their sample populations and establish effective interventions.[10,15,16]

In this article, we provide a succinct overview of these issues and a set of recommendations based on a “strength-based” approach. This approach focuses on finding common ground between patients, their support system, and the treatment team in the service of empowering patients to resume responsibility for transition to adulthood.


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