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Psychosocial, evidence-based interventions (EBI) may support personal recovery from psychosis; however, little is known about their implementation.: This paper describes the adaptation, implement...

Clinical staging models rest on the assumption that treatments that are offered earlier in the emergence of psychotic illness have the potential to be more effective, are safer and more affordable than those provided once illness has become entrenched. This chapter will introduce readers to clinical staging models and recent adaptations and consensus statements on the better provision of care for young people in the early stages of psychotic disorder. Trainees will learn about the potential benefits and risks of identifying and proactively treating individuals at risk of psychosis, will understand the evidence regarding the effectiveness of early intervention programs for psychosis, and be aware of challenges experienced in the implementation of early intervention services internationally and the benefits of including family and carers in treatment planning. The chapter will also discuss the multidisciplinary team make up of early intervention services, and gain a strong appreciation of the distinct contribution that psychologists—as research-practitioners—can provide in this context.

Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes. Aim The primary aim of the study is, in a population of young people with first-episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence-based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24-months follow-up. Methods Our single-blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2-year period in 180 remitted first-episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow-up. Results This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017. Conclusion This study will provide evidence as to whether an antipsychotic dose-reduction recovery treatment leads to improved functioning and safer outcomes in first-episode psychosis patients. In addition, it will be the first-controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population.

People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.

Our group has conducted several Internet investigations into the biobehavioural effects of recreational use of MDMA (Ecstasy) and other psychosocial drugs [1-5]. They have relied on self-reports of drug use. Here we report a new study examining the relationship between self-reported Ecstasy use and traces of MDMA found in hair samples.