Psychosocial Interventions for People with a First-Episode Psychosis: a Narrative and Critical Review

Objective Treatment guidelines for the treatment of psychotic disorders suggest evidence-based interventions. These interventions target several domains such as self-management of clinical symptoms, social, familial and love relationships as well as cognitive functioning. However, these general guidelines do not provide specific evidence for people with a first-episode psychosis (FEP). The objective of this narrative and critical review is to present evidence supporting the interventions suggested by the treatment guidelines that were validated in people with a FEP, particularly those interventions validated in French. Method Based on the international and national treatment guidelines, a narrative and critical review of the scientific literature conducted in people with FEP and focusing on two recommended interventions for psychotic disorders, cognitive-behavioral therapy for psychosis (CBTp) and cognitive remediation (CR), was performed. Administration modalities adapted to the participant's profile are important to consider in this type of intervention. We thus explored two promising modalities in people with FEP, the group format and the use of digital technologies. Results Several studies support the use of CBTp in people with FEP, including one Quebec study. The effects of CR are less promising in people with FEP compared to those with a chronic evolution of their psychotic illness (e.g. schizophrenia). However, some limitations of the included studies are identified and the specific improvements in people with FEP are presented. Regarding the group format and the digital technologies, most interventions currently available need to be systematically validated, and the results need to be replicated by other groups of researchers to obtain evidence-based results. Conclusion This narrative and critical review of the literature highlights the evidence available for CBTp and CR in people with FEP. The group format used in several interventions with this population reveals encouraging results, while interventions using digital technologies have shown their acceptability and feasibility, but the efficacy remains to be assessed. In addition to contributing to symptomatic recovery, psychosocial interventions also support functional and personal recovery in people with FEP. Nonetheless, some limitations are observed regarding the accessibility of such interventions. While some interventions are currently not available in French, other available evidence-based interventions are not currently systematically used in clinical settings. These limitations call for the importance of developing an implementation science for these interventions to improve the transfer of results from research to clinical settings as well as a service organization model that promote or facilitate access to such interventions.