Clinical practice points

Clinical practice points

Assessing and managing risk of violence in early psychosis

The overwhelming majority (approximately 90%) of people who experience mental ill‑health are not violent. Nonetheless, the rates of general violence in people with psychosis are estimated to be 4–5 times higher than the general population. Since rates of offending in the general community are highest during adolescence and early adulthood, young people with early psychosis may be particularly at risk of violence or offending. However, these risks can be reduced and effectively managed in treatment by targeting relevant risk and protective factors.

Managing incomplete recovery in first episode psychosis

While the vast majority of young people who develop a first episode of psychosis respond well to initial treatment and have a remission of their symptoms, some young people will continue to experience symptoms and thus show signs of early treatment resistance. Because early treatment response is thought to be one of the strongest predictors of subsequent outcome, preventing enduring symptoms of psychosis and associated impaired social functioning should be the primary aim of treatment for first episode psychosis (FEP).

Managing transitions in care for young people with early psychosis

Changes in a young person’s care can be confusing, disruptive and may require extra practical support for the young person and their family. Perhaps related to these factors, transitions in care also represent a period of increased risk for young people with early psychosis, including risk of suicide and risk of disengagement and therefore relapse and associated decline in functioning.

Working with cultural diversity in early psychosis

Cultural diversity is a fundamental feature of the Australian population. In 2011, it was reported that almost a quarter (24.6%) of Australia’s population was born overseas. The American Psychiatric Association states that ‘Culture refers to systems of knowledge, concepts, rules, practices that are learned and transmitted across generations…includes language, religion and spirituality, family structures, life-cycle stages, ceremonial rituals, and customs, as well as moral and legal systems.’

Preventing relapse in first episode psychosis

Managing and minimising the impact of relapse is an important component of treatment in first episode psychosis (FEP). Between 55–70% of people with FEP will experience a psychotic relapse within two years of remission of their initial episode. With each relapse, recovery becomes difficult and prolonged for the young person, and the risk of chronic or persistent symptoms increases.