Early Psychosis Intervention (EPI) is a specialized approach to providing services to individuals affected by psychosis. It is oriented toward the early recognition of psychosis and the provision of timely comprehensive treatments that are stage and age-appropriate.
A fundamental principle underlying provision of care for any health condition is that identification, diagnosis and treatment should occur as early as possible in order to maximize the likelihood that intervention will successfully minimize the burden of suffering, declines in a young person’s daily functioning and societal costs such as loss of productivity.
EPI strives to recognize psychosis as early as possible
Early refers to identifying and providing services to young people and their families as soon as possible after the first appearance of psychotic symptoms. EPI attempts to recognize psychosis as early as possible through an active case finding approach which involves extensive community education, engagement with gatekeepers (e.g., schools, parents, professionals who work with youth) and an open and accessible referral process with timely response.
When young people present for treatment for psychosis, they often have been experiencing symptoms for a period of time ranging from weeks to years. This period from the onset of full blown psychotic symptoms until adequate treatment is received is called the duration of untreated psychosis (DUP). There is strong evidence that a longer duration of untreated psychosis (DUP) is associated with poorer outcomes.
EPI involves a broad range of evidence-based interventions and supports
A key rationale for early intervention in psychosis is to limit disruptions to the young person’s social and role functioning as well as reducing suffering of symptoms and distress for the young person and those close to them.
Psychosis tends to emerge during the mid- to late teenage years and early twenties – an important developmental stage for young people in terms of their identity, independence, relationships, educational and long term vocational plans.
It is, therefore, important that interventions are provided to the young person with psychosis so that in addition to achieving a symptomatic recovery, he or she also achieves a functional recovery. Functional recovery refers to such things as a return to school or work, family and other social relationships, having a place to live, and addressing physical health needs.
EPI places a great emphasis on providing evidence-based interventions and supports to the family as well as the young person.
These supports seek to:
- Engage young people and families quickly and over time through a process of respect, clear communication and partnership in care
- Assist the person to return to school or pursue work as soon as possible to avoid more longstanding disability
- Reduce secondary problems such as depression, alcohol/other drug use problems or suicide
- Involve families as much as possible in education and treatment in order to reduce their distress and enable them to support their relative with psychosis
- Provide age and phase appropriate interventions.
- An example of age appropriate intervention is the creation of a youth-oriented culture of services that emphasizes engagement with young people and recognition of their individual needs.
- A phase appropriate example would be the provision of clozapine (a type of anti-psychotic medication) after starting with other antipsychotic drugs that were not effective in reducing symptoms.