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GENERAL CONSIDERATIONS

INTRODUCTION

Outcome in schizophrenia and related psychotic disorders remains relatively poor despite availability of antipsychotic medication and several highly efficacious psychological treatments. While outcome can be improved significantly through provision of integrated medical and psychosocial treatments in later stages of the illness, it is doubtful if the negative effect associated with delay in initial treatment can be eradicated entirely. At the very least the social consequences of delay in treatment for the patient and the family may be difficult to reverse.

Unfortunately a substantial proportion of patients experience long delays not uncommonly stretching to one to two years. However, a new optimism is beginning to emerge through provision of optimum treatment at a very early stage of the development of a psychotic illness.

Here we will provide the reader with a detailed description of a new early intervention program (PEPP). We have attempted to provide practical guidelines for setting up an early intervention program/service for psychotic disorders with special emphasis on assessment procedures and integrated phase specific treatment. While we have attempted to provide sufficient detail these modules cannot be considered training manuals. The latter may be obtained from the program on direct request. It must be emphasized that in order to provide optimum assessment and treatment as outlined in this package clinicians are advised to obtain specific training possibly through preceptorship programs. Details of these can be obtained by writing to our program.

PROGRAM PRINCIPLES

The following were adopted as guiding principles for PEPP:

  1. A valid conceptual model: The program is based on a stress-vulnerability model for understanding the development and progression of psychotic disorders.

  2. Integrated medical and psychosocial treatment: Emphasis is placed on integration of various biological and psychosocial modalities of treatment, which have proven efficacy, for each individual according to his/her needs.

  3. A modified assertive community treatment model for delivery of care: Based on empirical evidence and experience, including our own, we adopted a model of delivery in which assertive case management is provided to each individual according to his/her and the family’s needs.

  4. Assessment and treatment to be provided in the least restrictive environment and preferably in the patient’s choice of environment: This is to avoid unnecessary trauma resulting from hospitalization of young individuals who have had no previous experience with mental health services and to promote early integration of the individual with his/her family and the community.

  5. Promotion of early case detection and early intervention: It was considered necessary to promote strategies likely to improve early recognition of psychosis in the community so that individuals receive prompt assessment and treatment.

PROGRAM GOALS

We set the following goals for the program to be achieved within the first five years of its operation:

  1. To provide optimum, safe and integrated medical and psychosocial treatment to individuals with a first episode of psychosis living in our catchment area in accordance with each patient and her/his family’s needs.

  2. To promote early integration of persons presenting with a first episode of psychosis into their respective roles and responsibilities.

  3. To reduce delay in initiating treatment for psychosis through early case detection strategies for the whole community.

  4. To conduct research in early phases of psychosis.

  5. To conduct studies on prevention of syndromal level of psychotic disorders.

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