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Accessible Summary: What is known on the subject?: The admission of a loved one for first episode psychosis can cause considerable distress and confusion for family members.Psychoeducation can enhance family members' knowledge of the disease process and their role in supporting recovery. What this paper adds to existing knowledge: There is limited research on psychoeducation processes within adult inpatient settings.A Practitioner Narrative found that basic assessment questions can help guide the psychoeducation process. The Stress Vulnerability and Phases of Psychosis Models are valuable and efficient educational tools in answering many typical questions. What are the implications for practice?: Psychoeducation sessions should be offered routinely in the early stage of a first episode psychosis, but must be individualized to family needs and concerns.The psychoeducation structure also provides an opportunity for family members to "tell their story" to process the events leading up to a first admission and their emotional reactions to the service user's illness. Aim: To clarify how initial psychoeducation, while typically brief, can best be targeted to the needs of families during the acute treatment phase of a first episode of psychosis, when there is often significant distress and confusion. Method: Over 6 months of conducting inpatient psychoeducation meetings, with families of individuals experiencing first‐episode psychosis, a senior mental health nurse—as a practice development undertaking—kept a record of needs/issues expressed by families. Thesis: The most frequent needs of families during a first episode of psychosis were: 1. Opportunity to discuss events leading to admission; 2. Space to share feelings and fears; 3. Have practical information concerning current care; 4. Education regarding the nature of psychotic symptoms and 5. Information about recovery. Implications for Practice: Family members of individuals experiencing a first episode of psychosis often require an opportunity to process the events leading up to the admission, and their emotional reactions to the individual's illness and admission. The psychoeducation process can be individualized and targeted to the needs of families, with active listening to the family's stories. Psychoeducational frameworks that were useful for explaining issues raised were the Stress Vulnerability Model and the Phases of Psychosis. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery. [ABSTRACT FROM PUBLISHER]

Objectives: To review the characteristics of all patients presenting with a first episode of psychosis between the ages of 16 and 65 years to an adult area mental health service.Methods: The early psychosis programme at St Vincent's Hospital Melbourne treats all patients presenting in the early stages of psychosis between the ages of 16 and 65 years. A database was developed to capture the demographic and diagnostic characteristics of the group. The characteristics of those with an onset under 26 years were compared with those with a later onset.Results: A large proportion (55%) of those presenting with first episode psychosis presented after the age of 25 years. There were a higher number of cases of depression with psychotic features in the older onset patients (notably so for those over 40) and a trend towards greater metabolic morbidity.Discussion: Older patients presenting with a first episode of psychosis are relatively understudied but appear to have certain distinguishing qualities. Understanding the needs of these patients is important in tailoring optimal treatment packages and service responses. [ABSTRACT FROM AUTHOR]

Families play an important role in relapse-prevention following a person's first psychotic episode. To evaluate an open-ended family group intervention within a public adult mental health service, semi-structured interviews were conducted with: (1) carers who continually attended; (2) carers who attended once only; (3) carers who never attended; (4) case managers and (5) early psychosis clinicians. Benefits to group participation included: reduced isolation, sense of collective experience, opportunity to feel heard, reduced stigma and shame, increased knowledge about mental illness, and enhanced skills in supporting the care recipient. Barriers included: competing family and work commitments, applicability to own experiences of caring, discomfort with social situations and revealing and hearing emotions, and a belief that experiences are private. While attending the group increased knowledge, the benefits most emphasized were in the social connection with other carers and sharing one's story in a safe and reassuring environment. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluated a first-episode psychosis multiple-family psychoeducation carer group delivered within a mental health service. The study involved carers of people between 16 and 65 years of age, with a diagnosis of first-episode psychosis, receiving treatment from community clinics of St Vincent Mental Health Service, Melbourne, Victoria. The study showed the efficacy of the group in providing interventions for first-episode psychosis care.

Objective To evaluate the implementation of clinical practice guidelines in the initial stages of treatment of first episode psychosis, through use of a care pathway within one area mental health service. Methods A fidelity audit was undertaken using data from local Early Psychosis Care Pathway documents, completed for the cohort of clients with early psychosis seen in the first 2 years of an integrated early psychosis programme model, at St Vincent's Mental Health Service, Melbourne, Australia. Results The utilisation of a care pathway greatly supported both the documentation of clinical process and fidelity to clinical guidelines in early psychosis treatment. Excellent adherence (over 80%) was achieved for therapeutic alliance with the client, conducting a comprehensive bio-psychosocial assessment, medical investigations, reduction of client trauma and increased orientation to the service and the mental health systems of care, and for contact with family. Good adherence (over 70%) was achieved for client re-integration to the community and promotion of carer well-being; the service plans to focus on these areas in future service improvement initiatives, along with a focus on physical health assessment and enhancing primary care liaison. Conclusions The process of formally operationalizing and implementing clinical guidelines utilizing a care pathway within an area mental health service has proved to be an effective way to ensure fidelity with standard agency practices and protocols. The integrated approach, supported by quality assurance initiatives, provides an excellent goodness-of-fit within an established area mental health service. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Early Intervention in Psychosis: Evidence, Evidence Gaps, Criticism, and Confusion," by A.R. Yung in the January 2012 issue.