Treatment of first-episode psychosis patient, psychosocial aspects

Two large randomised clinical trials, the OPUS and the LEO trials, investigating specialised assertive intensive treatment in early phases of psychosis have been shown to have positive effects on clinical symptoms, substance abuse, and user satisfaction although only some of these positive effects are sustainable over time. At a five-year follow-up, there were no clinical differences between the specialised assertive intervention group and standard care, but significantly more intervention patients were able to live independently and spent significantly fewer days in hospital. As a consequence of these outcomes, a comparison of five years and two years of specialised assertive treatment is currently being undertaken. Crucial elements in specialised assertive intensive treatment are the assertive approach and family involvement, and there is also some evidence supporting the inclusion of cognitive behavioural therapy, supported employment and weight management.

► The early phase of psychosis is the most vulnerable phase with high risk of suicidal acts and social marginalisation.
► It is possible to improve the clinical course of illness through specialised assertive early intervention programmes.
► It is unclear how long treatment programmes should last, although it seems two years is too little.
► Early intervention services should adapt an assertive approach and include family involvement.
► Early intervention services should include focus on labour market affiliation, cognitive remediation, substance abuse and unhealthy life style.