CLINICAL HANDBOOK OF SCHIZOPHRENIA

368 VI. SPECIAL POPULATIONS AND PROBLEMSnumber of unsuccessful strategies to respond to these nonspecific symptoms and deterioratingcourse. The problem may be ignored or attributed to normal adolescent adjustment,or to other causes, such as mood disorders or addictions. The poor outcome fromthese strategies can lead frustration on the part of families and patients, and result in alack of confidence in clinicians and treatment services. Furthermore, it has been well establishedin the literature that young people often have a psychosis for many months oreven years before they receive adequate treatment. This delay in treatment is known asthe duration of untreated psychosis (DUP). A long DUP clearly can have terrible impacton the young person and his or her family in terms of distress and coping difficulties, andan obvious negative impact on psychological and social well-being. Although not proven,a biological impact has been suggested as well. A final reason for giving the first episodespecific attention is that positive psychotic symptoms in a first episode of psychosis, comparedto repeated episodes, are more likely to respond to antipsychotic pharmacotherapy.Paradoxically, observations of the natural history of treated psychosis suggest that thechances of relapse are greater in the early years of the disorder.The first episode of psychosis also has important research implications. These includestudying treatment-naive patients; studying more representative populations of patients,not just those with a more severe course; understanding the natural history of thedisorder; and finally, separating the effects of chronic illness from the underlying disorder.Special Treatment TeamsProviding treatment for people experiencing a first episode of psychosis involves developingboth an overall system of care and individualized treatment plans for patients andtheir families. The goals of the care system should be to promote early intervention andto support optimal individualized treatment for patients and families.Interestingly, there has been much discussion about the relative benefits of establishingspecialized teams to deal with the first-episode population. Organizational benefitsinclude enhancing the knowledge and skills of the team members, as well as systematicallyproviding professional and public education. Offering a specific program can facilitatebringing together groups of patients and their families while having the means tomove patients through well-established and effective care pathways.There may be drawbacks to special teams. There is still a limited evidence base forthe advantage of specialized treatment teams versus treatment as usual. Concerns that resourcesare allocated to a small group of patients at the expense of services for othergroups are often voiced. Of course, at the level of the individual, effective treatments for afirst episode of psychosis are similar to those for persons with a more chronic course ofillness. However, these specialized services can actually improve early access to services,and really make them more user-friendly for both patients and families. For these specializedfirst-episode services, funding often emerges as a political issue. It can be easier to arguefor funds for new and innovative service delivery models in an environment in whichmental health services often are not funded at levels equivalent to those for other healthservices. However, the absence of information based upon the evaluation of real servicesin the real world limits this discussion to opinion and experience.DESCRIPTION OF TREATMENT APPROACHESEarly-psychosis treatment can be divided into services that promote early interventionand those that promote optimal care once contact has been established with the treat-