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First Episode and Early Psychosis Program (FEPP)
What does FEPP offer?
The First-Episode and Early Psychosis Program (FEPP) of the Massachusetts General Hospital (MGH) was established to help patients and families around the time of a first episode of psychosis. FEPP is a research program that provides specialized evaluation, treatment, and education for people who are experiencing psychosis for the first time or who have been diagnosed with a psychotic disorder of recent onset (within one year). We offer the following services to eligible patients:
- Comprehensive medical and psychiatric evaluation
- Second opinion evaluations
- Medication treatment
- Psychological treatment (cognitive behavioral treatment or “CBT”)
- Family education about psychosis and schizophrenia
- Participation in research studies for interested patients, including
state-of-the-art imaging projects
What is a first episode of psychosis?
One of the hallmarks of beginning schizophrenia is psychosis: hallucinations, delusions, and a type of confusion that is called “disorganization.” The first time that somebody experiences psychosis is called first-break, or first-episode psychosis. There is usually a period before psychosis can be clearly detected, during which individuals may experience anxiety, sleep problems, difficulty functioning, nonspecific physical symptoms, and/or social isolation. This somewhat unspecific period is called the illness “prodrome.” Not everybody who has a first episode of psychosis will end up having schizophrenia. To make a diagnosis of schizophrenia requires that the illness lasts at least six months, so sometimes a diagnosis cannot be made with certainty until the illness has “declared itself” months or even years after the first episode of psychosis.
Why is early diagnosis important?
Timely diagnosis and treatment are important for several reasons: psychosis is a confusing and frightening condition that interferes with work, school and relationships, it is usually very treatable, and there might be medical causes that can mimic schizophrenia (but which require different treatments). Unfortunately, on average it takes over a year for someone experiencing psychosis to obtain adequate assessment and treatment because psychosis is often not recognized by mental health care professionals, families, peers, or the affected individual. The disorder typically strikes young adults in their 20s and 30s, at a time when they are making career and family decisions. Often, untreated patients who have delusions and hallucinations lose their job, drop out of school, or alienate their friends and family. Sometimes, there are problems with the law. These consequences have been termed the “social toxicity of psychosis.” However, if psychosis is treated early, these consequences may be prevented. There is also some research that suggests that the longer that patients wait to receive treatment for psychosis, the less complete their response to treatment because of changes in their brains.
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