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Evidence-based psychotherapy for the prevention and treatment of first-episode psychosis

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Abstract

The aim of psychotherapy among individuals at clinical high risk (CHR) for psychosis is to prevent transition to full-blown psychosis. Psychotherapy in individuals with a first-episode psychosis (FEP) aims to reduce relapse rates. Remission of (pre-) psychotic symptoms, psychosocial functioning, quality of life, comorbid disorders and self-esteem are also important outcomes in individuals at CHR and with FEP. Antipsychotics, Qmega-3-Fatty acids and psychotherapy have been found to be effective in CHR for most of these aims. Thereby psychotherapy presents a better benefit/risk ratio than antipsychotic medication. The most evidence-based intervention is cognitive-behavioral therapy (CBT). Psychotherapy is mostly offered to FEP patients within specialized early intervention services (including assertiveness community treatment and antipsychotic medication). Thereby, CBT is effective for positive symptoms and family intervention is particularly effective for the prevention of relapses. We introduce the principles of CBT for psychosis and suggest adaptions for individuals at CHR and FEP. We conclude that the needs of young people at CHR and with FEP are best met by specially designed, low threshold outpatient clinical services, which include intensive psychotherapy treatment. A number of countries have implemented early detection and intervention services based on this model, while the implementation within in Germany is still marginal.

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Acknowledgments

The authors received no funding for this review.

Conflict of interest

A.B. has received speaker fees from Bristol Myers Squibb, Eli Lilly, Janssen Cilag and has received support for investigator initiated trials by Bristol Myers Squibb. H.M. and S.L did not declare conflict of interests.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany

    Hendrik Müller & Andreas Bechdolf

  2. Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Academic Hospital Charite Medicine, Dieffenbachstrasse 1, 10967, Berlin, Germany

    Sonja Laier & Andreas Bechdolf

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Müller, H., Laier, S. & Bechdolf, A. Evidence-based psychotherapy for the prevention and treatment of first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 264 (Suppl 1), 17–25 (2014). https://doi.org/10.1007/s00406-014-0538-0

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