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Aubrey M Moe,1 Ellen B Rubinstein,2 Colin J Gallagher,3 David M Weiss,4 Amanda Stewart,1 Nicholas JK Breitborde1 1Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; 2Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; 3Department of Psychological Sciences, Kent State University, Kent, OH, USA; 4Department of Psychology, The Ohio State University, Columbus, OH, USA Abstract: Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder. Keywords: first-episode psychosis, early intervention, social ecology, emerging adulthood

Nicholas JK Breitborde,1,2 Aubrey M Moe,1 Arielle Ered,3 Lauren M Ellman,3 Emily K Bell4 1Department of Psychiatry and Behavioral Health, 2Department of Psychology, The Ohio State University, Columbus, OH, 3Department of Psychology, Temple University, Philadelphia, PA, 4Department of Psychiatry, University of Arizona, Tucson, AZ, USA Abstract: Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis. Keywords: first-episode psychosis; multicomponent care; psychosocial treatment; personalized medicine