Phases of Recovery Copy

Interventions should be targeted to the phase of psychosis

The interventions that need to occur for early psychosis can be conceptualized
as depending on the phase of psychosis or phase of recovery.

The phase of recovery can assist the clinician in targeting their efforts and resources while assisting the client and his or her family towards self-efficacy. The stage of grief, level of knowledge about mental health and experience with mental health services of the client and his or her family often influence expectations. Clinical approaches are best viewed within the context of the young person’s developmental needs, the family’s coping strategies and the period of time in which the symptoms have been present. In Module III, assessment tools will be explored which can offer the clinician further strategies for engaging the client and their family in the phases of the recovery.

The family should be actively engaged from the start of treatment and should be included as part of the treatment team. The goals of family involvement is to both ensure family well-being and improve client outcomes. View a PowerPoint presentation on the benefits of family involvement.

Acute phase:

  • Establish engagement with client and family
  • Provide symptomatic relief
  • Ensure safety and basic needs are met
  • Ensure family well-being and coping
  • Arrange for additional supports and resources as needed
  • Provide information about psychosis and treatments.
  • Explain your role
  • Explain mental health system and role of physicians & psychiatrists

The acute phase typically lasts several weeks once treatment is initiated.

Ideally, clients and families are seen at least two or three times per week with the goal of providing care in the least restrictive environment possible. This level of intensive care is necessary in order for community treatment to prevent the need of hospitalization. Hospitalization is often perceived as traumatic for young people with psychosis and should be avoided whenever possible. Of course, when there are safety and management issues that can not be controlled by community treatment, hospitalization will be required. When hospitalization is required, the clinician should coordinate this and ensure that the hospitalization process is clearly explained to both client and family.

Early recovery phase

  • Treatment of comorbidity (e.g., depression, anxiety, substance abuse)
  • Intensive psychoeducation working within the client’s and family’s explanatory model
  • Encourage adherence and monitor for side effects
  • Comprehensive assessment
  • Stress management
  • Relapse prevention
  • Other psychosocial intervention such as goal setting and problem solving
  • Gradually begin reintegration
  • Physical activities are important at this stage
  • Cognitive remediation techniques are helpful
  • Group psychoeducation and therapy approaches are beneficial and appropriate (only with skilled facilitator)

This phase frequently lasts several months and visits should occur about one to two times per week.

Later recovery phase

  • Continue to treat comorbidity, provide education and psychosocial interventions
  • Relapse prevention planning is crucial
  • Group interventions may be arranged
  • Referral to therapist specializing in other comorbid issues
  • Greater efforts to fully reintegrate (may include use of peer support, schooling, job training, social skill training, etc.)
  • Monitoring for medication side effects and return of symptoms

Visits are about once per week, moving to once per month as recovery progresses.

Recovery takes time and the rate of recovery depends on many factors and will vary from individual to individual. However, sometimes recovery is prolonged – a client may not respond to medication fully, symptoms persist and there are significant obstacles to reintegration. Prolonged recovery needs to be identified and actively treated in an effort to change course. We will further explore recovery in later modules.

Video on Recovery

Here we’ll again hear from the same three young perople you saw in previous videos in the first module. In this video (4:52 mins), they talk about their experience of recovery from psychosis.

Although early intervention for psychosis is a relatively new field, there is a growing body of literature evaluate the evidence-base of certain interventions including pharmacotherapy, family intervention and cognitive therapy.

Click here for a summary of the evidence base for interventions in early psychosis.

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