Management of first-episode psychosis

Over recent years early intervention in psychosis has fired the imagination of clinicians and researchers, following the publication of several studies linking a long duration of psychosis prior to receiving treatment with a poor treatment outcome: a relationship that has been cogently argued to be independent of illness factors (e.g. Scully et al, 1997). Most influential was Wyatt’s (1991) review of 22 studies, in which relatively similar groups of patients suffering from schizophrenia were, or were not, given antipsychotic medication early in the course of their illness. This pointed towards an improved long-term course in schizophrenia with early treatment. At the same time, evidence was emerging that the early phase following the onset of a first psychotic illness could be conceived of as a critical period, influencing the long-term course of the illness. During this period individuals and their families may also develop adverse psychological reactions to psychosis and the circumstances of its management. It was therefore proposed that timely and effective intervention at this stage might alter the subsequent course of the illness (Birchwood et al, 1998). The early intervention concept has even been extended, with some success, in an attempt to identify people experiencing the prodrome of a first episode of psychosis (Yung et al, 1998). These developments resulted in the establishment of specialised services for the management of firstepisode psychosis, notably in Australia and Scandinavia. In the UK, the National Service Framework for Mental Health stresses the necessity of prompt assessment of young people at the first sign of a psychotic illness, in light of the “growing evidence that early assessment and treatment can reduce levels of morbidity” (Department of Health, 1999: p. 44). The Government’s plan for the National Health Service (NHS) specifically targets the funding of 50 early intervention services by 2004. The primary aims in the management of firstepisode psychosis are detailed in Box 1. In this paper, we will describe best-practice principles for the management of first-episode psychosis, illustrating them with reference to their application in our service, the Birmingham Early Intervention Service. This is the UK’s first dedicated service for young people with a first episode of psychosis, which has recently been granted NHS Beacon Service status. Management of first-episode psychosis