Schizophrenia Program

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First-episode and Early Psychosis Program

The First-episode and Early Psychosis Program (FEPP) at Mass General evaluates and treats people in the critical early stages of schizophrenia or related psychotic illnesses.

Father and son attending a therapy session

Father and son attending a session

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A Full Range of Treatment and Support

Mass General’s First-episode and Early Psychosis Program (FEPP) offers highly specialized evaluation,treatment and education for people in the early stages of schizophrenia or who may be experiencing psychosis for the first time.

Early intervention is the core of our program’s mission. Research shows that early diagnosis and treatment can help people recover from their illness more quickly.

It can also lessen the problems typically associated with untreated psychosis, such as unemployment, substance abuse, hospitalization, disruption to relationships, law-breaking and suicidal behavior.

Our program offers:

  • State-of-the-art medical and psychological evaluation
  • Medication treatment
  • Education and family support
  • Cognitive behavioral therapy, a form of talk therapy
  • Research-based care

What to Expect

We strive to schedule evaluations within 48 hours of our first contact with the patient. Appointments are typically available within two weeks.

All patients entering our program undergo a full clinical evaluation by a team of psychiatrists, psychologists and social workers who specialize in diagnosing and treating people with schizophrenia to determine:

  • Whether the patient has actually experienced psychosis
  • Whether other physical problems such as alcohol or drug abuse might be causing the symptoms
  • The nature and severity of the psychosis
  • Which treatments have the best chance of success

Occasionally a patient may disagree with our clinical determination regarding whether psychosis is present. In these cases, we can still help the patient manage problems areas such as sleep disturbance, anxiety, depression or stress-related problems.

Program participation is limited to two years. At that point, we will evaluate the patient’s need for continued treatment and assist with a transition to longer term care, as appropriate.

Medication

Our doctors and nurse practitioners aim to prescribe the lowest effective doses and fewest possible number of medications. We understand there is a need for balance in taking psychiatric medications, and we strive to ensure that the benefits outweigh any possible side effects. Open communication around medication is strongly encouraged.

We consider not only the psychiatric well-being of patients but also the physical well-being. We recognize that many of the medications we prescribe to help manage psychiatric symptoms are associated with weight gain and metabolic changes and we monitor and address this issue.

An FEPP doctor may determine that medication may be an effective option to help patients:

  • Function at a higher level by reducing stress, anxiety and sleep problems
  • Shorten the duration of psychotic symptoms
  • Prevent symptoms from recurring

Used in combination with cognitive behavioral therapy and family education and support, medication can also decrease stress so patients can participate more effectively in their therapy.

Learn more about our Weight-loss and Diabetes program.

Cognitive Behavioral Therapy ("Talk Therapy")

In many mental health centers, standard patient care consists of medication management combined with case management. Many patients don’t even have access to therapy.

Mass General offers a highly specialized treatment known as cognitive behavioral therapy (CBT). Originally developed to treat depression, CBT is a form of “talk” therapy that has been demonstrated to be highly effective in treating distress, anxiety and other symptoms associated with psychosis. A CBT therapist can help:

  • Identify and modify problematic behaviors
  • Develop coping strategies to help patient’s copy with symptoms and unproductive thinking patterns
  • Discuss advantages and disadvantages of medication

FEPP patients typically attend 16 sessions including 3 to 4 sessions of guidance and support for family members during the first 6 to 8 months of treatment.

Family Education and Support

Education for patients and family members is a cornerstone of our care model. We partner with families to ensure they understand the disease and equip them with coping strategies.

We also teach family members to assist patients with their recovery by:

  • Reinforcing the patient’s strengths, such as participating in treatment
  • Monitoring medication compliance in the early phases of recovery
  • Recognizing signs of relapse

Staff in this program

Staff in this program

About this Program

The First-episode and Early Psychosis Program (FEPP) is one of more than 50 specialty clinical and research programs in the Department of Psychiatry.

FEPP evaluates and treats people who:

  • Are experiencing psychosis for the first time
  • Have never taken antipsychotic medication or have been taking it for less than 6 months
  • Are between the ages of 14 and 40
  • Are residents of Greater Boston

We also strongly support the use of education—of families, of medical professionals, of the general public—to decrease the stigma surrounding psychotic illness and improve access to care for those who suffer.

Unfortunately, we do not currently treat patients with co-occurring developmental disorders, such as Asperger’s disorder and psychosis.

Why "First" and "Early?"

People experiencing psychosis may wait months or even years before seeking treatment for several reasons:

  • The early stages of the illness are often difficult to recognise
  • People with psychosis often don’t see themselves as ill and believe their symptoms are temporary
  • Fear and stigma often prevent people from seeking help

It is also not uncommon for patients and their families to deny the problem altogether—or simply try to wish it away.

Part of our program's mission is to spread the message that psychosis rarely goes away on its own. In fact, the longer it goes untreated, the more severe it can become. The Mass General team specializes in the detection of psychosis, which is often missed by general practitioners.

That's why the most successful FEPP patients are those who recognize and seek treatment for their symptoms of psychosis as early as possible.

Research-based Care

All of our psychiatrists and psychologists are uniquely trained as clinicians, researchers and teachers and are leaders in their field.

Our primary research goal is to better understand the effects of psychosis on the brain in order to develop new and more effective treatments.

First-episode and Early Psychosis Program (FEPP)

Massachusetts General Hospital
Department of Psychiatry Wang Building Suite 815
55 Fruit Street
Boston, MA 02114

Phone: 617-724-7792

Public Transportation Access: yes
Disabled Access: yes