The need-adapted integrated treatment in Sant Pere Claver-Early Psychosis Program (SPC-EPP) in Barcelona, Spain

SUMMARYInternational interest has grown over the past 15 years in the prognosticpotential of early identification and intervention in the prodromal andfirst-episode phases of psychosis. This focus is associated with increasingoptimism about the benefits of implementing treatment as early aspossible in the course of psychosis, at least to help improve the courseof illness, reducing its long-term impact.A clearer framework for guiding, designing, and evaluatingpreventive interventions in mental disorders has been developed. Asa consequence, a series of research projects and real-world servicessystems are currently emerging. Additionally, several influentialinternational figures and research groups have developed andcooperated in disseminating a more optimistic set of ideas concerningearly intervention in psychosis.The early psychosis programs developed worldwide have anumber of common elements and goals: a) early detection of newcases, b) reducing the duration of untreated psychosis (DUP), and c)providing better and continued treatment during the «critical period»of the early years of the disorder.Moreover, family interventions usually offer psychoeducationand/or individual and group family therapy, in conjunction withcommunication and problem solving training, which can help todevelop coping strategies and reduce distress and burden.Intervention programs in early psychosis are usually composedby interdisciplinary teams, providing a wide range of integratedservices that typically include psychoeducation, clinical casemanagement, and group interventions. Specific interventionsgenerally include pharmacotherapy, stress management, relapseprevention, social and employment rehabilitation support, andcognitive and family therapy.The current challenges in the implementation of psychologicalinterventions in the early stages of psychosis are: 1. to adapt treatmentmodalities that have been proven effective in stable and residual stagesof the disease to its early stages; 2. to develop new forms of therapytailored to the specific characteristics of these early stages of psychosis;and 3. treatment packages need to be individually tailored to specificneeds rather than applied homogenously across early psychosis patients.One example of the integration of all these aspects is the «need-adapted integrated treatment» developed by Alanen et al. in Finland,which combines different forms of treatment in a flexible, individuallydesigned intervention in order to take into account the needs of bothpatients and families.Following the experience and work of Alanen et al., an EarlyPsychosis Program (EPP) currently is being developed in the MentalHealth Services of Sant Pere Claver in Barcelona, addressed to youngpeople between 14 and 35 years with at risk mental states (ARMS),first episode psychosis (FEP), and post-crisis stages of psychosis.All cases included in the program are derived from variouscommunity resources (primary health care, schools, emergency services,and inpatient units for acute patients) and assessed exhaustively by theteam to define the treatment plan for each case. The treatmentmodalities offered by the EPP are: individual and group therapy,unifamiliar and multifamiliar psychotherapy, psychoeducation andpharmacotherapy in those cases where necessary. Furthermore, thereis an intensive community support for those patients who have difficultiesengaging with mental health services. During the EPP all patients aremonitored through weekly visits with their psychiatrist, psychologist,social worker and/or nursing staff.The aim of this paper is to present and describe the integratedneed-adapted treatment approach of the early psychosis programcurrently being developed in a specialized center in Barcelona (Spain). Key words: Early detection and intervention, early psychosis,psychotherapeutic approach, need-adapted treatment.RESUMENLos trastornos del espectro psicotico presentan un curso cronico yepisodico que provoca alteraciones en todas las areas de la vida,generando importantes grados de discapacidad, perdida de funcio-nes psicosociales, grandes costes economicos, una comorbilidadconsiderable y sufrimiento tanto para los pacientes como para susfamilias. A pesar de que el tratamiento farmacologico y psicosocialha ayudado a aliviar los sintomas y mejorar la calidad de vida, en