[Specific treatment of the first psychotic episodes]

Early detection and early intervention programs in early adolescent and young adult psychosis have developed in many countries and have shown their effectiveness. The main lesson of these programs is to have demonstrated that the progression of at-risk mental state into to a full-blown psychosis or of a psychotic episode to a chronic schizophrenic disorder is evitable. They have also shown that the earlier appropriate care is set up the better the functional remission and that the period of "early psychosis" encompassing the period preceding the emergence of psychosis and the first months after the first psychotic episode, is a period of opportunity for a preventive or curative intervention. Specialized therapeutic strategies shall include patient's centered integrative care. According to international recommendations, early intervention provides an extensive multidisciplinary assessment in search of possible organic etiologies and in instrumental to adapt care strategies to the person's need. It helps to identify levers for a psychosocial approach (psychoeducation, cognitive and behavioral therapies, cognitive remediation, case management) and for adressing aggravating factors (substance use, family interventions, educational support, etc.). A second-generation antipsychotic should be introduced, at lower doses than for a chronic disorder. The young patient must be accompanied until recovery by a specialized multidisciplinary team, usually for a period of 2 to 3 years. Deployment of such programs is a societal challenge and represents a paradigm shift: it questions the practices and organization of the healthcare system, but also the way healthcare professionals and the general public look at these diseases. In France, the Transition Network, a founding member of the French-speaking branch of IEPA, aims to facilitate the dissemination of these practices on a National scale, and to help to harmonize emerging initiatives.