6.+Psychosocial+Interventions

It is important to remember that everyone’s personal experience of psychosis is different; therefore the course and outcome of treatment will vary among persons. Sometimes symptoms go away rather quickly and people are able to resume their regular life right away, whereas others may need several weeks to recover. If left untreated, the condition can worsen and dramatically disrupt the lives of individuals and families (CAMH, 2012).
 * Treatment for Drug Induced Psychosis **

Early Psychosis Intervention:
The goal of early intervention is to recognize the early signs of psychosis so treatment can begin right away. The early intervention program reaches out to: persons experiencing their first psychotic episode, persons with suspected psychosis, persons who have a family history of psychotic disorder, and persons experiencing a recent deterioration in their ability to function. Early intervention provides clinical services and education to the affected individual and his/her family, with the aim of promoting wellness, reducing socially isolating behaviour, and restoring previous levels of functioning (Fraser Health, 2011). Early psychosis intervention has been proven to be effective in reducing and even preventing the symptoms of a psychotic episode (CMHA, 2013). However, early Intervention strategies can be challenging because in the early stages of psychosis people often do not know what is happening to them and do not seek treatment right away. **Eppic**: The Early Psychosis Prevention and Intervention Centre (EPPIC) is an integrated and comprehensive mental health service aimed at addressing the needs of people aged 15-24 with a first episode of psychosis in the western and north-western regions of Melbourne (CAMH, 2012).

Psychosocial Interventions:
A combination of both antipsychotic medication and psychosocial interventions are utilized for the treatment of psychosis. Psychosocial treatment strategies are aimed at allowing the individual to maintain their daily routines as much as possible. The goal is to promote a fast and full recovery wherein individuals are able to effectively cope with their illness and recognize their potential (CMHA, 2013). CAMH and CMHA provide a range of psychosocial services to individuals with psychotic symptoms including: case management, supportive psychotherapy, group therapy, individual CBT, and vocational counselling. A **case manager** or therapist provides: emotional and social support to the individual and their family, education about the psychotic symptoms and management of the illness, and practical assistance with daily activities. This assistance helps the individual get back into their daily routine, as well as links them with community supports that can contribute to their long-term recovery. **Supportive psychotherapy** can be very therapeutic for individuals who feel frightened, confused, and overwhelmed from their first episode of psychosis. It aims to help the individual accept the illness and move forward in personal growth. Individuals can meet with a therapist to make sense of their condition, examine the impact on self-esteem, and learn how to cope and adapt. **Group therapy** allows a forum for individuals to socialize with others who are struggling with similar experiences. This group offers education about the illness, development of coping strategies, adjustment to illness, and social support along the road of recovery. Group members have the opportunity to learn from others and realize they are not alone in this struggle. **Individual cognitive behavioural therapy** helps those recovering from psychosis to work on coping more effectively with stress, recognizing the impact of drugs on psychotic symptoms, and finding alternative healthy ways to cope with illness. Ultimately, the goal of this therapy is to reduce symptoms and create functional ways of thinking and behaving. **Vocational counseling** is offered to help individuals dealing with first episode psychosis through school and work problems. An occupational therapist explores client’s interests and uses skill-oriented evaluations to assess their strengths and challenges in the context of work or school. This promotes a successful transition for the client as they re-enter into their community (CAMH, 2012).

Cognitive Behavioural Therapy (CBT) and Family Intervention (FI):
CBT and FI are recognized as leading therapies in the treatment of psychosis, supported by strong research evidence for its effectiveness. CBT is found to reduce psychotic symptoms and FI to reduce relapse (Garety, 2003). Thus, the combination of these therapies would work well in the case of a drug-induced psychosis.

Psychosis can be conceptualized within a stress-vulnerability framework, which explains the usefulness of CBT and FI. CBT aims to help the client understand psychosis in the least distressing way, while managing unwanted experiences and preventing further recurrences. A CB therapist works with the client towards a new understanding as the client is encouraged to identify irrational thoughts/beliefs, review the evidence for such thoughts/beliefs, and challenge these cognitive distortions relating to mood and behavior. Client is also encouraged to try new ways of behaving and thinking between sessions. CBT is slightly modified for patients with psychosis so that early stages of therapy are longer (to engage clients who are suspicious) and as least stressful as possible (Garety, 2003).

Furthermore, families are invaluable allies and their involvement is an extremely important part of the treatment plan. Family Interventions draws on the stress-vulnerability model of psychosis and aim to reduce the risk of relapse in vulnerable individuals by altering the source of stress – the family environment (Garety, 2003). Family counseling, psychoeducational workshops, and support groups are offered for the family so they can learn about the nature of the illness and how to relate to or support their recovering relative. This includes learning to communicate in a calm and clear manner, as well as avoiding overwhelming the relative with too much information. Family members must also understand recovery takes time and it is best to take a structured approach wherein the individual gradually takes on activities and tasks. These therapeutic methods provide the family with ongoing emotional support and education regarding the illness and treatment (CAMH, 2012).