TY - JOUR
T1 - The clinical characterization of the patient with primary psychosis aimed at personalization of management
AU - Maj, Mario
AU - van Os, Jim
AU - De Hert, Marc
AU - Gaebel, Wolfgang
AU - Galderisi, Silvana
AU - Green, Michael F.
AU - Guloksuz, Sinan
AU - Harvey, Philip D.
AU - Jones, Peter B.
AU - Malaspina, Dolores
AU - McGorry, Patrick
AU - Miettunen, Jouko
AU - Murray, Robin M.
AU - Nuechterlein, Keith H.
AU - Peralta, Victor
AU - Thornicroft, Graham
AU - van Winkel, Ruud
AU - Ventura, Joseph
N1 - Funding Information:
Johan Detraux and Davy Vancampfort (University Psychiatric Centre KU Leuven, Kortenberg, Belgium) contributed to the section on physical comorbidities. Erika Jääskeläinen (University of Oulu, Finland) and John McGrath (Aarhus University, Denmark, and University of Queensland, St. Lucia, Australia) contributed to the section on family history.
Publisher Copyright:
© 2021 World Psychiatric Association
PY - 2021/2
Y1 - 2021/2
N2 - The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
AB - The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
KW - environmental exposures
KW - family history
KW - internalized stigma
KW - negative dimension
KW - neurocognition
KW - obstetric complications
KW - personalization of treatment
KW - physical comorbidities
KW - positive dimension
KW - practical needs
KW - Primary psychosis
KW - protective factors
KW - psychiatric antecedents
KW - psychiatric comorbidities
KW - psychosocial interventions
KW - recovery
KW - resilience
KW - schizophrenia
KW - social cognition
KW - social functioning
UR - http://www.scopus.com/inward/record.url?scp=85099090522&partnerID=8YFLogxK
U2 - 10.1002/wps.20809
DO - 10.1002/wps.20809
M3 - Article
C2 - 33432763
SN - 1723-8617
VL - 20
SP - 4
EP - 33
JO - World Psychiatry
JF - World Psychiatry
IS - 1
ER -