• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Blogs » The Carlat Psychiatry Blog » Quick Tips: First Episode Psychosis

The Carlat Psychiatry Blog
The Carlat Psychiatry Blog RSS FeedRSS

Keeping psychiatry honest since 2003.
News and opinions on mental health from Dr. Carlat, the editorial team, and guest contributors.

Quick Tips: First Episode Psychosis

March 25, 2019

When we see patients with a first episode of psychosis, it can be difficult to know what the diagnosis is, and how to proceed with treatment. The Carlat Psychiatry Report spoke with Ann Shinn, MD, Director of Clinical Research, Schizophrenia and Bipolar Disorder Research Program, McLean Hospital, for some tips on doing interventions. Here’s what Dr. Shinn recommends:





Ask about “basic symptoms.” Even before a patient presents with a first episode of frank psychosis, many will report basic symptoms, which are subtle symptoms such as derealization, depersonalization, feeling existentially vulnerable, and experiencing the body as strange or different. You can elicit some of these symptoms by asking questions such as, “Does the world ever feel strange, unreal, or otherwise changed? Have you ever felt dangerously exposed, or too open or transparent, even though there was no specific reason to feel this way?” In one study of 160 patients with prodromal psychosis, such basic symptoms predicted transition to schizophrenia with a probability of 70% over almost 10 years of follow-up (Klosterkotter J et al, ArchGen Psychiatry 2001;58(2):158–164).





While medications are usually necessary in first episode psychosis, Dr. Shinn recommends using “gentle” pharmacology, meaning the lowest effective dose to minimize risk of side effects. Remember that most first-episode patients are drug-naïve. You want to engage a person in treatment, and not have their first experience with meds be negative. She adds that we know from the CATIE trial that about 75% of patients over an 18-month period stop medications, either because of side effects or because they were not very effective.





Remember that medications are important, but not sufficient. A more integrated approach is key. A paper in AJP (Kane JM et al, Am J Psychiatry 2016;173(5):535-536) showed that an integrated team based approach is more effective than treatment as usual. This includes individual therapy, family psychoeducation, and employment and education support—in addition to medication. Traditional treatment approaches focus on symptomatic recovery, using antipsychotics to target positive symptoms. But to really help patients with psychosis get back on track with their lives, we need to do more to help people develop good coping skills and social skills, and help them navigate school, work, and relationships.





Dr. Shinn says get your patients involved in shared decision making. Patients (especially younger patients) are more likely to follow through with plans when they have a say.


Introducing Carlat Total Access Subscriptions

Complete access to every article you search on the website.

Shop for Total Access
Free Psychiatry Updates
The latest unbiased psychiatric information sent to your inbox.
Specify Your Interests
Featured Book
  • AUDFB1e_CoilBound_Graphic2_transparent_sm.png

    Treating Alcohol Use Disorder: A Fact Book (2023)

    All the tools and information needed to assess and treat your patients who are struggling with...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto45285952.jpg
    Hospital Psychiatry

    Confused About Acute Confusional States? A Primer on Delirium

    Delirium is widespread among patients in ICUs and surgery units. In this podcast, we will review the workup and management of this common condition and give you tips to help...

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.