doctor and therapist coordinating care for a patient with psychosis
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Summary: Research shows the best treatment for first episode psychosis is an approach called coordinated specialty care (CSC).

Key Points:

  • Psychosis refers to the experience of having delusions or hallucinations, i.e. seeing, hearing, and feeling (touch) things that aren’t there.
  • Mental health providers developed coordinated specialty care in the early 2000s as a way to treat young adults after an initial psychotic episode, called first episode psychosis.
  • Coordinated specialty care (CSC) prioritizes early intervention and a multimodal, collaborative approach to treatment for first episode psychosis.
  • A large scale research effort called Recovery After an Initial Schizophrenia Episode (RAISE) initiated in 2008 identifies CSC as the most effective approach to helping people after a first episode of psychosis, decrease risk of subsequent episodes, and prevent or reduce long-term disability.

What is Coordinated Specialty Care (CSC)?

The RAISE report – Evidence-Based Treatments for First Episode Psychosis: Components of Coordinated Specialty Care – included this comprehensive definition of CSC:

“Coordinated Specialty Care (CSC) is a team-based, multi-element approach to treating FEP that has been broadly implemented in Australia, the United Kingdom, Scandinavia, and Canada. Component interventions include assertive case management, individual or group psychotherapy, supported employment and education services, family education and support, and low doses of select antipsychotic agents.”

In the U.S., the National Institute on Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and the American Psychiatric Association (APA) identify Coordinated Specialty Care (CSC) as first-line approach to treating first episode psychosis.

The APA identifies the following components of CSC:

Coordinated Specialty Care: Core Components

Collaborative Decision-Making:

    • Evidence indicates collaboration between providers, patients, and families using a team-based approach improves outcomes and reduces stigma. This approach stresses combining provider expertise with the lived experience of the patient and family.

Psychotherapy:

    • Cognitive behavioral therapy for psychosis (CBTp): CBT for psychosis may occur in individual, family, or group settings. Evidence shows that CBTp can reduce distress caused by symptoms of psychosis, and improve psychosocial function.

Medication:

    • Medication is the standard first-line treatment for psychosis, but recent research suggests that using medication for early psychosis/first episode psychosis in some patients can extend the duration of untreated psychosis (DUR), and lead to negative outcomes, as compared to following the CSC model. When an assessment indicates the need for medication, a person with early onset psychosis may receive a prescription for:
      • Typical antipsychotics
      • Atypical antipsychotics

Case Management:

    • Evidence suggests treatment outcomes improve when a case manager coordinates care in collaboration with patient, family, and provider.

Family Participation: Education, Support:

    • Families play a crucial role in the treatment of early onset psychosis. When the family learns about the symptoms of psychosis and the facts about mental health disorders involving psychosis, outcomes improve because family members understand how they can support their loved one as they learn to manage symptoms of psychosis.

Peer and Community Support:

    • Community and peer support groups help people with emerging symptoms of psychosis understand they don’t have to go through everything by themselves. Learning from peers who’ve learned to manage hallucinations and delusions associated with early onset psychosis can make a big difference. Patients will often listen to people who have been there and done that over people who have neither been there nor done that.

Vocation, Education, and Lifestyle:

    • The CSC approach is multidisciplinary. It’s specifically constructed to help a person with early onset psychosis thrive in all life domains. This means the treatment process involves creating opportunities for education and vocational training appropriate for people who experience the symptoms of psychosis.

It also means teaching patients how to maximize their healing potential with lifestyle changes and educational workshops that improve overall health and wellness, including:

  • Exercise and activity
  • Healthy eating
  • Mindfulness and distress tolerance
  • Sleep hygiene
  • Social/relationship skill building
  • Eliminating/reducing alcohol and substance use

The CSC approach implies that a full and productive life is possible for people with psychosis and for people with disorders involving psychosis. We’ll elaborate on this below.

Finding Balance After First Episode Psychosis

Evidence suggests that roughly 100,000 people under age 25 experience FEP each year. When left untreated, an escalation to a disorder like schizophrenia can have significant negative consequences. Untreated psychosis and psychotic disorders can create serious disruption in the following areas of life, including:

  • Work
  • School
  • Social life/interactions with peers
  • Partner/romantic relationships
  • Family relationships

While treatment is essential, early treatment for FEP is optimal, and ongoing care results in the most favorable outcomes. Early intervention with the CSC model can accurately identify and diagnose disorders in need of support. Experts indicate ongoing care with CSC can:

  • Improve clinical outcomes
  • Reduce transition to schizophrenia and other disorders with psychosis
  • Improve functional outcomes across life domains

The components of CSC in the previous section clarify why the approach is effective: it addresses all areas of life that may impact mental health and psychosis. Beyond those core considerations, CSC provides the following advantages:

  1. Treatment with providers who specialize in FEP.
  2. Support for mental health at home, in clinical settings, and in the community.
  3. Methods for managing acute mental health crises.
  4. Methods for managing the immediate aftermath of mental health crises.
  5. Organized, progress-based movement through levels of care, from most immersive to least immersive, over a period of 2-3 years.

While experiencing first episode psychosis can be both disorienting and frightening for the person having delusions and/or hallucinations and their family and friends, we want anyone reading this article to take away these important facts:

Not all people with FEP develop full psychosis. With early diagnosis and appropriate, timely intervention, it’s possible to manage symptoms, minimize disruption, and live a full, fulfilling, and productive life.

As is true with all mental health disorders, the earlier a person who needs evidence-based treatment gets evidence -based treatment, the better the outcome.

Finding Help: Resources

If you or someone you know needs professional treatment and support for first episode psychosis, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources: