Early intervention in psychosis#North America

There are a number of functional components of the early psychosis model,Edwards, J. & McGorry, P.D. (2002) (eds). Implementing Early Intervention in Psychosis. A guide to establishing early psychotic services. London. Martin Dunitz.{{cite journal|author=International Early Psychosis Association Writing Group|year=2005|title=International clinical practice guidelines for early psychosis|journal=British Journal of Psychiatry|volume=Supplement 48|pages=s120–s124|doi=10.1192/bjp.187.48.s120|pmid=16055801|doi-access=free}}{{cite journal |author=Marshall M |author2=Lockwood A |author3=Lewis S |author4= Fiander M |year=2004 |title=Essential elements of an early intervention service for psychosis: the opinions of expert clinicians |journal=BMC Psychiatry |volume=4 |page=17 |pmid=15230978 |doi=10.1186/1471-244X-4-17 |pmc=455683 |doi-access=free }} and they can be structured as different sub-teams within early psychosis services. The emerging pattern of sub-teams are currently:

Multidisciplinary clinical teams providing an intensive case management approach for the first three to five years. The approach is similar to assertive community treatment, but with an increased focus on the engagement and treatment of this previously untreated population and the provision of evidence based, optimal interventions for clients in their first episode of psychosis. For example, the use of low-dose antipsychotic medication is promoted ("start low, go slow"), with a need for monitoring of side effects and an intensive and deliberate period of psycho-education for patients and families that are new to the mental health system. In addition, research showed that family intervention for psychosis (FIp) reduced relapse rates, hospitalization duration, and psychotic symptoms along with increasing functionality in first-episode psychosis (FEP) up to 24 months.Camacho-Gomez M, Castellvi P. Effectiveness of family intervention for preventing relapse in first-episode psychosis until 24 months of follow-up: a systematic review with meta-analysis of randomized controlled trials [published online May 3, 2019]. Schizophr Bull. doi: https://doi.org/10.1093/schbul/sbz038 Interventions to prevent a further episodes of psychosis (a "relapse") and strategies that encourage a return to normal vocation and social activity are a priority. There is a concept of phase specific treatment for acute, early recovery and late recovery periods in the first episode of psychosis. {{cite journal |last1=Byrne |first1=P |title=Managing the acute psychotic episode |journal=BMJ |date=2007 |volume=334 |issue=686 |pages=686–692 |doi=10.1136/bmj.39148.668160.80 |pmid=17395949 |url=https://www.bmj.com/content/334/7595/686 |access-date=15 March 2024|pmc=1839209 }}

Interventions aimed at avoiding late detection and engagement of those in the course of their psychotic conditions.{{cite journal|author=Larsen TK|author2=Friis S|author3=Haahr U|author4=Joa I|author5=Johannessen JO|author6=Melle I|author7=Opjordsmoen S|author8=Simonsen E|author9=Vaglum P|year=2001|title=Early detection and intervention in first-episode schizophrenia: a critical review|journal=Acta Psychiatrica Scandinavica|volume=103|issue=5|pages=323–334|doi=10.1034/j.1600-0447.2001.00131.x|pmid=11380302|s2cid=24479187}} Key tasks include being aware of early signs of psychosis and improving pathways into treatment.{{cite journal |vauthors=Johannessen JO, McGlashan TH, Larsen TK, etal |title=Early detection strategies for untreated first-episode psychosis |journal=Schizophr. Res. |volume=51 |issue=1 |pages=39–46 |date=August 2001 |pmid=11479064 |doi=10.1016/S0920-9964(01)00237-7 |s2cid=7361138 }} Teams provide information and education to the general public and assist GPs with recognition and response to those with suspected signs, for example: EPPIC's Youth Access Team (YAT){{cite web|url=http://www.eppic.org.au/acute-care-1 |title=Youth Access Team (YAT) Staff |access-date=2009-02-14 |url-status=dead |archive-url=https://web.archive.org/web/20100225083234/http://www.eppic.org.au/acute-care-1 |archive-date=February 25, 2010 }} (Melbourne); OPUS (Denmark); TIPS{{cite web |url=http://www.tips-info.com|title=TIPS webpage |access-date=2009-02-14}} (Norway); REDIRECT{{cite journal |author=Tait L |author2=Lester H |author3=Birchwood M |author4=Freemantle N |author5= Wilson S |year=2005 |title=Design of the BiRmingham Early Detection In untREated psyChosis Trial (REDIRECT): cluster randomised controlled trial of general practitioner education in detection of first episode psychosis [ISRCTN87898421] |journal=BMC Health Services Research |volume=5 |issue=1 |page=19 |pmid=15755321 |doi=10.1186/1472-6963-5-19 |pmc=1082907 |doi-access=free }} (Birmingham); LEO CAT (London){{cite journal|author=Power P|author2=Iacoponi E|author3=Reynolds N|author4=Fisher H|author5=Russell M|author6=Garety P|author7=McGuire PK|author8=Craig T|year=2007|title=The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis|journal=British Journal of Psychiatry|volume=Supplement 51|pages=s133–s139|doi=10.1192/bjp.191.51.s133|pmid=18055931|doi-access=free}} "; STEP's Population Health approach to early detection.{{Cite journal|last1=Srihari|first1=Vinod H.|last2=Jani|first2=Anant|last3=Gray|first3=Muir|date=2016-02-01|title=Early Intervention for Psychotic Disorders|journal=JAMA Psychiatry|language=en|volume=73|issue=2|pages=101–2|doi=10.1001/jamapsychiatry.2015.2821|pmid=26747524|issn=2168-622X}}{{Cite journal|last1=Srihari|first1=Vinod H.|last2=Tek|first2=Cenk|last3=Pollard|first3=Jessica|last4=Zimmet|first4=Suzannah|last5=Keat|first5=Jane|last6=Cahill|first6=John D.|last7=Kucukgoncu|first7=Suat|last8=Walsh|first8=Barbara C.|last9=Li|first9=Fangyong|date=2014-12-04|title=Reducing the duration of untreated psychosis and its impact in the U.S.: the STEP-ED study|journal=BMC Psychiatry|volume=14|page=335|doi=10.1186/s12888-014-0335-3|pmid=25471062|pmc=4262386|issn=1471-244X |doi-access=free }}

The development and implementation of quantitative tools for early detection of at-risk individuals is an active research area. This includes development of risk calculators{{cite journal | vauthors = Fusar-Poli, P, Rutigliano, G, Stahl, D, Davies, C, Bonoldi, I, Reilly, T, McGuire, P | year = 2017 | title = Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis | journal = JAMA Psychiatry | volume = 74 | issue = 5 | pages = 493–500 | doi = 10.1001/jamapsychiatry.2017.0284| pmid = 28355424 | pmc = 5470394 }} and methods for large-scale population screening.{{cite journal | vauthors = Raket LL, Jaskolowski J, Kinon BJ, Brasen JC, Jönsson L, Wehnert A, Fusar-Poli P | year = 2020 | title = Dynamic ElecTronic hEalth reCord deTection (DETECT) of individuals at risk of a first episode of psychosis: a case-control development and validation study | journal = The Lancet Digital Health | volume = 2 | issue = 5 | pages = e229–e239 | doi = 10.1016/S2589-7500(20)30024-8| pmid = 33328055 | doi-access = free }}

Prodrome or at risk mental state clinics are specialist services for those with subclinical symptoms of psychosis or other indicators of risk of transition to psychosis. The Pace Clinic{{cite web |url=http://www.orygen.org.au/contentPage.asp?pageCode=ATRISK#paceclin |title=ORYGEN Youth Health |access-date=2009-02-20 |archive-url=https://web.archive.org/web/20091024170333/http://www.orygen.org.au/contentPage.asp?pageCode=ATRISK#paceclin |archive-date=2009-10-24 |url-status=dead }} in Melbourne, Australia, is considered one of the origins of this strategy,{{cite journal |doi=10.1093/schbul/22.2.283 |vauthors=Yung AR, McGorry PD, McFarlane CA, Jackson HJ, Patton GC, Rakkar A |title=Monitoring and care of young people at incipient risk of psychosis |journal=Schizophr Bull |volume=22 |issue=2 |pages=283–303 |year=1996 |pmid=8782287 |doi-access=free }} but a number of other services and research centers have since developed.{{cite journal |vauthors=Broome MR, Woolley JB, Johns LC, etal |title=Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state |journal=Eur. Psychiatry |volume=20 |issue=5–6 |pages=372–8 |date=August 2005 |pmid=16171652 |doi=10.1016/j.eurpsy.2005.03.001 |s2cid=27207646 }}

Yale Medical School based clinic | [http://info.med.yale.edu/psych/clinics/prime/pintro.html PRIME] These services are able to reliably identify those at high risk of developing psychosis{{cite journal |vauthors=Yung AR, Phillips LJ, Yuen HP, etal |title=Psychosis prediction: 12-month follow up of a high-risk ("prodromal") group |journal=Schizophr. Res. |volume=60 |issue=1 |pages=21–32 |date=March 2003 |pmid=12505135 |doi= 10.1016/S0920-9964(02)00167-6|s2cid=31342026 }} and are beginning to publish encouraging outcomes from randomised controlled trials that reduce the chances of becoming psychotic,{{cite journal |vauthors=McGorry PD, Yung AR, Phillips LJ, etal |title=Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms |journal=Arch. Gen. Psychiatry |volume=59 |issue=10 |pages=921–8 |date=October 2002 |pmid=12365879 |doi=10.1001/archpsyc.59.10.921 |doi-access=free |hdl=10536/DRO/DU:30151296 |hdl-access=free }} including evidence that psychological therapy{{cite journal |vauthors=Morrison AP, French P, Parker S, etal |title=Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk |journal=Schizophr Bull |volume=33 |issue=3 |pages=682–7 |date=May 2007 |pmid=16973786 |pmc=2526150 |doi=10.1093/schbul/sbl042}} and high doses of fish oil{{cite journal | author = Amminger | author2 = Schäfer | author3 = Papageorgiou | author4 = Harrigan | author5 = Cotton | author6 = McGorry | author7 = Berger | year = 2008 | title = Indicated Prevention of Psychotic Disorders with Long-Chainomega-3 Fatty Acids: A Randomized, Placebo-Controlled Trial | journal = Schizophrenia Research | volume = 102 | issue = 1–3| page = 252 | doi=10.1016/s0920-9964(08)70758-8| s2cid = 53301111 }} have a role in the prevention of psychosis. However, a meta-analysis of five trials found that while these interventions reduced risk of psychosis after 1 year (11% conversion to psychosis in intervention groups compared to 32% in control groups), these gains were not maintained over 2–3 years of follow-up.{{cite journal | author = Preti A, Cella M | year = 2010 | title = Randomized-controlled trials in people at ultra high risk of psychosis: a review of treatment effectiveness | journal = Schizophrenia Research | volume = 123 | issue = 1| pages = 30–36 | doi=10.1016/j.schres.2010.07.026| pmid = 20727717 | s2cid = 28017135 }} These findings indicate that interventions delay psychosis, but do not reduce the long-term risk. There has also been debate about the ethics of using antipsychotic medication to reduce the risk of developing psychosis, because of the potential harms involved with these medications.{{cite journal | author = Jorm AF | year = 2012 | title = Ethics of giving antipsychotic medication to at-risk young people | journal = Australian and New Zealand Journal of Psychiatry | volume = 46 | issue = 9| pages = 908–909 | doi=10.1177/0004867412455233| pmid = 22802552 | s2cid = 206398433 }}

In 2015, the European Psychiatric Association issued guidance recommending the use of the Cognitive Disturbances scale (COGDIS), a subscale of the basic symptoms scale, to assess psychosis risk; a meta-analysis conducted for the guidance found that while rates of conversion to psychosis were similar to those who meet Ultra High Risk (UHR) criteria up to 2 years after assessment, they were significantly higher after 2 years for those patients who met the COGDIS criteria.{{cite journal|last1=Schultze-Lutter|first1=F.|last2=Michel|first2=C.|last3=Schmidt|first3=S.J.|last4=Schimmelmann|first4=B.G.|last5=Maric|first5=N.P.|last6=Salokangas|first6=R.K.R.|last7=Riecher-Rössler|first7=A.|last8=van der Gaag|first8=M.|last9=Nordentoft|first9=M.|last10=Raballo|first10=A.|last11=Meneghelli|first11=A.|last12=Marshall|first12=M.|last13=Morrison|first13=A.|last14=Ruhrmann|first14=S.|last15=Klosterkötter|first15=J.|title=EPA guidance on the early detection of clinical high risk states of psychoses|journal=European Psychiatry|volume=30|issue=3|year=2015|pages=405–416|issn=0924-9338|doi=10.1016/j.eurpsy.2015.01.010|pmid=25735810|s2cid=20973529}} The COGDIS criteria measure subjective symptoms, and include such symptoms as thought interference, where irrelevant and emotionally unimportant thought contents interfere with the main line of thinking; thought block, where the current train of thought halts; thought pressure, where thoughts unrelated to a common topic appear uncontrollably; referential ideation that is immediately corrected; and other characteristic disturbances of attention and the use or understanding of language.

Early intervention in psychosis is a preventive approach for psychosis that has evolved as contemporary recovery views of psychosis and schizophrenia have gained acceptance. It subscribes to a "post Kraepelin" concept of schizophrenia, challenging the assumptions originally promoted by Emil Kraepelin in the 19th century, that schizophrenia ("dementia praecox") was a condition with a progressing and deteriorating course. The work of Post, whose kindling model, together with Fava and Kellner, who first adapted staging models to mental health, provided an intellectual foundation. Psychosis is now formulated within a diathesis–stress model, allowing a more hopeful view of prognosis, and expects full recovery for those with early emerging psychotic symptoms. It is more aligned with psychosis as continuum (such as with the concept of schizotypy) with multiple contributing factors, rather than schizophrenia as simply a neurobiological disease.

Within this changing view of psychosis and schizophrenia, the model has developed from a divergence of several different ideas, and from a number of sites, beginning with the closure of psychiatric institutions signaling a move toward community based care.{{cite journal | author = Falloon I.R. | year = 1992 | title = Early intervention for first episodes of schizophrenia: A preliminary exploration | journal = Psychiatry | volume = 55 | issue = 1| pages = 4–15 | pmid = 1557469 | doi = 10.1080/00332747.1992.11024572 }} In 1986, the Northwick Park study{{cite journal|author=Johnstone EC|author2=Crow TJ|author3=Johnson AL|author4=MacMillan JF|year=1986|title=The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission|journal=British Journal of Psychiatry|volume=148|issue=2|pages=115–120|doi=10.1192/bjp.148.2.115|pmid=3697578|s2cid=31369353}} discovered an association between delays to treatment and disability, questioning the service provision for those with their first episode of schizophrenia. In the 1990s, evidence began to emerge that cognitive behavioural therapy was an effective treatment for delusions and hallucinations.{{cite journal |vauthors=Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R, O'Carroll M, Barnes TR |title=A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication |journal=Arch. Gen. Psychiatry |volume=57 |issue=2 |pages=165–72 |date=February 2000 |pmid=10665619 |doi= 10.1001/archpsyc.57.2.165|doi-access= }}{{cite journal |vauthors=Kuipers E, Garety P, Fowler D, Dunn G, Bebbington P, Freeman D, Hadley C |title=London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: effects of the treatment phase |journal=Br J Psychiatry |volume=171 |issue=4 |pages=319–27 |date=October 1997 |pmid=9373419 |doi= 10.1192/bjp.171.4.319|s2cid=38736138 }}{{cite journal |vauthors=Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, Siddle R, Drake R, Everitt J, Leadley K, Benn A, Grazebrook K, Haley C, Akhtar S, Davies L, Palmer S, Faragher B, Dunn G |title=Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes |journal=Br J Psychiatry Suppl |volume=43 |pages=s91–7 |date=September 2002 |pmid=12271807 |doi=10.1192/bjp.181.43.s91|doi-access=free }} The next step came with the development of the EPPIC early detection service in Melbourne, Australia in 1996{{cite journal |doi=10.1093/schbul/22.2.305 |author=McGorry PD |author2=Edwards J |author3=Mihalopoulos C |author4=Harrigan SM |author5=Jackson HJ |year=1996 |title=EPPIC: an evolving system of early detection and optimal management |journal=Schizophrenia Bulletin |volume= 22 |issue=2 |pages=305–326 |pmid=8782288 |doi-access=free }} and the prodrome clinic led by Alison Yung. This service was an inspiration to other services, such as the West Midlands [http://www.iris-initiative.org.uk IRIS] group, including the carer charity Rethink Mental Illness; the TIPS early detection randomised control trial in Norway; and the [https://web.archive.org/web/20101103163825/http://opuskbh.dk/genveje/in-english/ Danish OPUS trial]. In 2001, the United Kingdom Department of Health called the development of early psychosis teams "a priority".Department of Health. (2001) The mental health policy implementation guide. London: Department of Health. The International Early Psychosis Association, founded in 1998, issued an international consensus declaration together with the World Health Organization in 2004.{{cite web |url= http://earlypsychosis.medicine.dal.ca/services/EPdeclaration.pdf |title=Early Psychosis Declaration: An International Consensus Statement about Early Intervention and Recovery for Young People with Early Psychosis. Jointly issued by the World Health Organization and International Early Psychosis Association |date=28 September 2004}}{{cite journal|author=Bertolote J|author2=McGorry P|year=2005|title=Early intervention and recovery for young people with early psychosis: consensus statement|journal=British Journal of Psychiatry|volume=Supplement 48|pages=s116–s119|doi=10.1192/bjp.187.48.s116|pmid=16055800|doi-access=free}} Clinical practice guidelines have been written by consensus.

There is evidence that providing access to specialized early intervention services results in benefits to patients during treatment. Such services lead to higher satisfaction among patients, and patients who have access to specialized early intervention services are more likely to stay in treatment, according to a 2020 Cochrane review. The same review also found that early intervention improved long-term global functioning outcomes; however, the evidence for this conclusion was of a lower quality, and all studies included in the review had been conducted in high-income countries, so it is not clear how these result will translate to lower-income countries. It is also unclear whether the benefits derived from early intervention persist once the patient is transferred to non-specialized treatment.{{Cite journal |last1=Puntis |first1=Stephen |last2=Minichino |first2=Amedeo |last3=De Crescenzo |first3=Franco |last4=Harrison |first4=Rachael |last5=Cipriani |first5=Andrea |last6=Lennox |first6=Belinda |date=2020-11-02 |editor-last=Cochrane Schizophrenia Group |title=Specialised early intervention teams for recent-onset psychosis |journal=Cochrane Database of Systematic Reviews |language=en |volume=2021 |issue=2 |pages=CD013288 |doi=10.1002/14651858.CD013288.pub2 |pmc=8092671 |pmid=33135811}}

One argument in favor of creating early intervention services is that they not only improve clinical outcomes for individual patients, but also cost less than standard services to operate, for example by reducing in-patient costs.{{Cite journal| doi = 10.1111/j.1751-7893.2009.00145.x| pmid = 22642729| title = Economic impact of services for first-episode psychosis: a decision model approach| year = 2009| last1 = McCrone | first1 = P.| last2 = Knapp | first2 = M.| last3 = Dhanasiri | first3 = S.| journal = Early Intervention in Psychiatry| volume = 3| issue = 4| pages = 266–273 | s2cid = 30407696}}{{cite journal |vauthors=Mihalopoulos C, McGorry PD, Carter RC |title=Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome? |journal=Acta Psychiatr Scand |volume=100 |issue=1 |pages=47–55 |date=July 1999 |pmid=10442439 |doi=10.1111/j.1600-0447.1999.tb10913.x|s2cid=24815565 |doi-access=free }} A systematic review conducted in 2019 concluded that there is evidence to support this claim; however, many of the available studies on the cost-effectiveness of these services have methodological flaws, and it is unclear whether their results will translate to lower-income countries.{{Cite journal |last1=Aceituno |first1=David |last2=Vera |first2=Norha |last3=Prina |first3=A. Matthew |last4=McCrone |first4=Paul |date=July 2019 |title=Cost-effectiveness of early intervention in psychosis: systematic review |journal=The British Journal of Psychiatry |language=en |volume=215 |issue=1 |pages=388–394 |doi=10.1192/bjp.2018.298 |issn=0007-1250|doi-access=free |pmid=30696495 }} Another review conducted in 2020 likewise found low-certainty evidence that early intervention reduces the risk of subsequent in-patient hospitalization.

The United Kingdom has made significant service reform with their adoption of early psychosis teams following the first service in Birmingham set up by Professor Max Birchwood in 1994 and used as a blueprint for national roll-out, with early psychosis now considered as an integral part of comprehensive community mental health services. The Mental Health Policy Implementation Guide outlines service specifications and forms the basis of a newly developed fidelity tool.Birchwood, unpublished. There is a requirement for services to reduce the duration of untreated psychosis, as this has been shown to be associated with better long-term outcomes. The implementation guideline recommends:

• 14 to 35 year age entry criteria
• First three years of psychotic illness
• Aim to reduce the duration of untreated psychosis to less than 3 months
• Maximum caseload ratio of 1 care coordinator to 10–15 clients
• For every 250,000 (depending on population characteristics), one team
• Total caseload 120 to 150
• 1.5 doctors per team
• Other specialist staff to provide specific evidence based interventions

In Australia the EPPIC initiative provides early intervention services.{{cite web | url=http://www.eppic.org.au/psychosis | title=Site disabled | orcmanage.unimelb.edu.au}} In the Australian government's 2011 budget, $222.4 million was provided to fund 12 new EPPIC centres in collaboration with the states and territories.{{cite web |url=http://www.pm.gov.au/press-office/2011-12-budget-offers-greater-support-fo-mental-health-patients |title=2011-12 Budget offers greater support for mental health patients | Prime Minister of Australia |access-date=2013-04-13 |archive-url=https://web.archive.org/web/20130424045758/http://www.pm.gov.au/press-office/2011-12-budget-offers-greater-support-fo-mental-health-patients |archive-date=2013-04-24 |url-status=dead }} However, there have been criticisms of the evidence base for this expansion and of the claimed cost savings.Raven M. Evaluating evidence for Early Psychosis Prevention and Intervention Centres (EPPIC). The Conversation 2 Nov 2011 http://theconversation.com/evaluating-evidence-for-early-psychosis-prevention-and-intervention-centres-eppic-3604{{cite journal | author = Amos A | year = 2013 | title = An axeman in the cherry orchard: early intervention rhetoric distorts public policy | journal = Aust N Z J Psychiatry | volume = 47 | issue = 4| pages = 317–320 | doi = 10.1177/0004867412471438 | pmid = 23568159 | s2cid = 8198295 }}{{cite journal | author = Jorm AF | year = 2013 | title = Do early intervention for psychosis services really save money? | journal = Aust N Z J Psychiatry | volume = 47 | issue = 4| pages = 396–7 | doi = 10.1177/0004867412461959 | pmid = 23015749 | s2cid = 32272758 }}

On August 19, 2011, Patrick McGorry, South Australian Social Inclusion Commissioner David Cappo AO and Frank Quinlan, CEO of the Mental Health Council of Australia, addressed a meeting of the Council of Australian Governments (COAG), chaired by Prime Minister Julia Gillard, on the future direction of mental health policy and the need for priority funding for early intervention.http://www.coag.gov.au/ "COAG Meeting 19th August 2011 The invitation, an initiative of South Australian Premier Mike Rann, followed the release of Cappo's "Stepping Up" report, supported by the Rann Government, which recommended a major overhaul of mental health in South Australia, including stepped levels of care and early intervention.Center for National Policy, Washington DC; "What States Can Do:Reform Mental Health", August 8, 2012

New Zealand has operated significant early psychosis teams for more than 20 years, following the inclusion of early psychosis in a mental health policy document in 1997.Blueprint for mental health service. There is a national early psychosis professional group, New Zealand Early Intervention for Psychosis Society (NZEIPS),{{cite web |url=http://www.earlypsychosis.org.nz |title=National Early Intervention Group - Aotearoa/New Zealand |website=www.earlypsychosis.org.nz |url-status=dead |archive-url=https://web.archive.org/web/20060506053436/http://earlypsychosis.org.nz/ |archive-date=2006-05-06}} organising a biannual training event, advocating for evidenced based service reform and supporting production of local resources.

Early psychosis programmes have continued to develop from the original TIPS services in Norway.{{Update inline|date=August 2023}}

In Denmark, an early intervention programme called OPUS was introduced as a randomized trial between 1998 and 2000.{{cite journal|author=Petersen L|author2=Nordentoft M|author3=Jeppesen P|author4=Ohlenschaeger J|author5=Thorup A|author6=Christensen TØ|author7=Krarup G|author8=Dahlstrøm J|author9=Haastrup B|year=2005|title=Improving 1-year outcome in first-episode psychosis: OPUS trial|journal=British Journal of Psychiatry|volume=187|issue=Supplement 48|pages=s98–s103|doi=10.1192/bjp.187.48.s98|pmid=16055817|author10=Jørgensen P|doi-access=free}} The trial was considered successful and OPUS was subsequently made the standard treatment programme for people aged 18–35. Later analysis of the effects of the programme conducted in 2021 showed that it had not only maintained its effects from the first trial, but that it had in fact been even more effective following its nationwide adoption as the standard treatment.{{Cite journal |last1=Posselt |first1=Christine Merrild |last2=Albert |first2=Nikolai |last3=Nordentoft |first3=Merete |last4=Hjorthøj |first4=Carsten |date=October 2021 |title=The Danish OPUS Early Intervention Services for First-Episode Psychosis: A Phase 4 Prospective Cohort Study With Comparison of Randomized Trial and Real-World Data |url=https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20111596 |journal=American Journal of Psychiatry |volume=178 |issue=10 |pages=941–951 |doi=10.1176/appi.ajp.2021.20111596 |pmid=34315283 |issn=0002-953X|url-access=subscription }}{{Cite web |title=OPUS er mindst lige så effektiv i den virkelige verden som i forsøgsperioden |url=https://www.psykiatri-regionh.dk/presse-og-nyt/Forskningsresumeer/Sider/OPUS-er-mindst-lige-s%C3%A5-effektiv-i-den-virkelige-verden-som-i-fors%C3%B8gsperioden.aspx |access-date=2023-08-19 |website=www.psykiatri-regionh.dk |language=da-DK}}

Canada has extensive coverage across most provinces, including established clinical services and comprehensive academic research in British Columbia (Vancouver), Alberta (EPT in Calgary), Quebec (PEPP-Montreal), and Ontario (PEPP, FEPP).

In the United States, the Early Assessment Support Alliance (EASA) is implementing early psychosis intervention throughout the state of Oregon.{{cite web | url=http://www.oregon.gov/oha/amh/pages/services/easa/main.aspx |title = Oregon Health Authority : Addictions and Mental Health Services : Addictions and Mental Health Services : State of Oregon}}

In the United States, the implementation of coordinated specialty care (CSC), as a recovery-oriented treatment program for people with first episode psychosis (FEP), has become a US health policy priority.{{cite web|url=https://www.ncbi.nlm.nih.gov/labs/articles/27851843/|title=What It Will Take to Make Coordinated Specialty Care Available to Anyone Experiencing Early Schizophrenia: Getting Over the Hump|website=PubMed Journals|language=en|access-date=2017-09-19}} CSC promotes shared decision making and uses a team of specialists who work with the client to create a personal treatment plan. The specialists offer psychotherapy, medication management geared to individuals with FEP, family education and support, case management, and work or education support, depending on the individual's needs and preferences. The client and the team work together to make treatment decisions, involving family members as much as possible. The goal is to link the individual with a CSC team as soon as possible after psychotic symptoms begin{{cite web|url=https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-coordinated-specialty-care-csc.shtml|title=NIMH » What is Coordinated Specialty Care (CSC)?|website=www.nimh.nih.gov|language=en|access-date=2017-09-19}} because a longer period of unchecked and untreated illness might be associated with poorer outcomes.{{Cite journal|last1=Harrigan|first1=S. M.|last2=McGorry|first2=P. D.|last3=Krstev|first3=H.|date=January 2003|title=Does treatment delay in first-episode psychosis really matter?|journal=Psychological Medicine|volume=33|issue=1|pages=97–110|issn=0033-2917|pmid=12537041|doi=10.1017/s003329170200675x|s2cid=202244541}}{{Cite journal|last1=Addington|first1=J.|last2=Van Mastrigt|first2=S.|last3=Addington|first3=D.|date=February 2004|title=Duration of untreated psychosis: impact on 2-year outcome|journal=Psychological Medicine|volume=34|issue=2|pages=277–284|issn=0033-2917|pmid=14982133|doi=10.1017/s0033291703001156|s2cid=145714003}}{{Cite journal|last1=Wunderink|first1=A.|last2=Nienhuis|first2=F. J.|last3=Sytema|first3=S.|last4=Wiersma|first4=D.|date=April 2006|title=Treatment delay and response rate in first episode psychosis|journal=Acta Psychiatrica Scandinavica|volume=113|issue=4|pages=332–339|doi=10.1111/j.1600-0447.2005.00685.x|issn=0001-690X|pmid=16638078|s2cid=1770126}}{{Cite journal|last1=Kane|first1=John M.|last2=Robinson|first2=Delbert G.|last3=Schooler|first3=Nina R.|last4=Mueser|first4=Kim T.|last5=Penn|first5=David L.|last6=Rosenheck|first6=Robert A.|last7=Addington|first7=Jean|last8=Brunette|first8=Mary F.|last9=Correll|first9=Christoph U.|date=2016-04-01|title=Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program|journal=The American Journal of Psychiatry|volume=173|issue=4|pages=362–372|doi=10.1176/appi.ajp.2015.15050632|issn=1535-7228|pmc=4981493|pmid=26481174}}

The first meeting of the Asian Network of Early Psychosis (ANEP) was held in 2004. There are now established services in Singapore,{{cite web |url=http://www.epip.org.sg/ |title=Epip |publisher=Epip |access-date=2009-02-14}} Hong Kong{{cite web |url=http://www3.ha.org.hk/easy/chi/index.html |title=「思覺失調」服務計劃 |publisher= ha.org.hk |access-date=2009-02-14}} and South Korea{{cite web |url=http://youthclinic.org/ |title=youth clinic |publisher= youthclinic.org |access-date=2009-02-14}}

{{Portal|Psychiatry}}

• Pediatric schizophrenia
• Schizophrenia
• Recovery model
• Deinstitutionalisation

{{reflist|2}}

• [http://www.eppic.org.au Early Psychosis Prevention and Intervention Centre] ({{Webarchive|url=https://web.archive.org/web/20060613063730/http://eppic.org.au/ |date=2006-06-13 }}) (EPPIC)
• [https://web.archive.org/web/20081218181532/http://www.rethink.org/about_mental_illness/early_intervention/index.html Rethink: What is Early Intervention] (UK)
• [http://www.iris-initiative.org.uk Initiative to Reduce Impact of Schizophrenia] (IRIS)
• [http://www.psychosissucks.ca Psychosis sucks], British Columbia, Canada
• [http://www.tips-info.com TIPS], Stavanger, Norway
• [http://www.rapprogram.org The Recognition and Prevention Program] (RAP), Glen Oaks, NY, USA
• [http://www.easacommunity.org Early Assessment and Support Alliance] Oregon, USA
• [http://www.step.yale.edu Program for Specialized Treatment Early in Psychosis, STEP] New Haven, CT, USA

Category:Early psychosis

Category:Psychiatric rehabilitation

Category:Treatment of mental disorders

Category:Treatment of psychosis