Early Psychosis: Diagnosis and Treatment

Background: The typical age of onset for psychotic disorders is concurrent with the typical age of enrollment in higher education. College and graduate students often experience new academic and social demands that may leave them vulnerable to substance use and mental health problems, including the initial onset of a psychotic episode. Objective: To provide a current overview of the guidelines and literature for the diagnosis and treatment of early psychosis with special consideration for the college and graduate student population in the United States. To highlight areas of need and provide recommendations for clinicians who work at educational institutions and their health services, along with general psychiatrists and psychologists who work with post-secondary education populations, to help close the treatment gap. Methods: A review of interventions and best practice for the treatment of early psychosis in college students was conducted, informed by the authors’ current experience as clinicians working with this population at a university in the United States. Results: Thorough psychiatric interviews and screening tools can help in the early identification of individuals at clinical high risk for, and at the first onset of, psychosis. Coordinated specialty care services are the gold standard for early psychosis and include psychotherapy interventions (such as cognitive behavioral therapy and individual resiliency training), as well as support for a student to return to school or work. Individuals experiencing a first episode of psychosis, in general, respond better to lower doses of antipsychotics and may also experience more adverse effects. Conclusion: Return to a high level of functioning is possible in many cases of early psychosis, with early identification and treatment essential.