After several years, there is a renewed focus on treatment for first psychotic episodes. An emphasis on early intervention and prevention of psychosis, with the goal of shortening the "duration of untreated psychosis" has obscured the view on the actual services that are being offered to individuals in the midst of a first episode…..
Recently, the National Institute of Mental Health challenged the psychiatric field to develop a new, state-of-the-art intervention for an "initial schizophrenic episode" (RAISE), realizing that the outcome of conventional treatment leaves a lot to be desired….
Interventions that fit this bill have been around for many years. Even going back to the days of moral treatment in the 19th century, one can find many instances of early recovery when people responded to the kind guidance and structure available in the best asylums. Scandinavian psychiatrists have long been at work to optimize interventions for first psychotic episodes, integrating family treatment, individual psychotherapy, optimal and targeted use of medication into a flexible package they termed "need-adapted treatment."
Several studies using variations of this approach have shown dramatically positive results, with little use of inpatient services, and much lower medication dosages than usual. Rather than wait for the results of the RAISE project, which are not likely to become available for several years, the time is now to look at some of the tried and true, but non-traditional options. Questions such as when, how and how much medication is best applied; whether hospitalization is always necessary, or can frequently and safely be replaced by homelike residential settings, or even by services provided in the persons home, thus preserving the integrity of the family and the support system.
Is the danger of psychosis to the person experiencing it and the social environment exaggerated in the service of minimizing risk and liability for the helping professions? Can we find viable ways of engaging the suffering person's own agency - her own reflective powers - as part of passage through the crisis? These questions and more will be addressed at a one-day conference on November 23, 2009, at the NYU Kimmel Center, co-sponsored by the International Network towards Alternatives and Recovery, (INTAR) and the Center to Study Recovery in Social Contexts.