CLINICAL HANDBOOK OF SCHIZOPHRENIA

382 VI. SPECIAL POPULATIONS AND PROBLEMSEarly work at PACE indicated that young people meeting these intake criteria had a40% chance of developing a psychotic episode in the 12 months after recruitment, despitethe provision of supportive counseling, case management, and antidepressant medication,if required. This substantial “transition to psychosis” statistic provided good supportfor the validity of the PACE criteria in identifying the UHR population. Since themid-1990s, multiple centers internationally have adopted these criteria.Subsequent studies at PACE have included intervention trials that comprised bothpsychological and pharmacological treatments. These are reviewed briefly, along with thegeneral treatment approach adopted by the PACE Clinic.GENERAL TREATMENT MEASURESInformation GivingThe rationale for use of the clinical service needs to be explained to the patient at initialassessment. This explanation should cover the dual focus of the clinical service—treatmentof current symptoms and disability, and prevention of full-blown psychotic disorder. It ispossible that being labeled as high risk for psychotic disorder may lead to stigmatizationof the individual, both by others and by the person him- or herself. The PACE Clinic hasaddressed this issue in a number of ways: The choice of name avoids any direct referenceto mental health; the location of the clinic is in a suburban shopping center, anonstigmatizing and acceptable environment for young people; information is providedsensitively, emphasizing that psychosis is not the inevitable result of UHR status, thatmonitoring of mental state is available, and that timely intervention is provided if symptomsworsen, and that the individual’s UHR status will remain confidential; ongoing opportunitiesfor discussion of risk and normal developmental challenges are provided; andreferral to other mental health services that also emphasize early intervention and focuson recovery.Case ManagementCase management refers to helping the patient deal with practical issues, such as arrangingaccommodation, arranging social security payments, enrolling in education, applyingfor employment, and liaising with other services. Case management is provided in additionto specific psychological and pharmacological interventions. This is important,because neglecting difficulties in more fundamental aspects of daily living may have animpact on the efficacy of the therapy and increase the patient’s level of stress.Crisis ManagementAlthough the UHR population does not meet full DSM criteria for a psychotic disorder, itis not uncommon for these patients to experience crises. Therefore, risk issues need to betaken into account. It is necessary to have emergency and after-hours services available orto be able to tell young people how to access after-hours support should they need it.Family InterventionsFamily members are often distressed and anxious about the changes they have noticed intheir UHR relative. Support for these family members is helpful. Psychoeducation aboutbeing at high risk for psychosis should be provided to family members to deal with their