First-Episode and Early Psychosis Program

The First-Episode and Early Psychosis Program (FEPP) at Massachusetts General Hospital evaluates and treats people who:

• Are experiencing psychosis for the first time
• 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 and of the general public—to decrease the stigma surrounding schizophrenia and psychotic illness, and improve access to care for those who suffer from psychosis. We do not treat patients with co-occuring developmental disorders such as autism spectrum disorders.

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 recognize
• 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 want 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 FEPP team specializes in the detection and evaluation of psychosis, which is often missed by general practitioners.

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

Our Services

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, interruption of education and suicidal behavior.

Our program offers:

• State-of-the-art medical and psychological evaluation
• Diagnostic second opinion consultations
• Medication treatment
• Education and family support
• Cognitive behavioral therapy, a form of talk therapy

For Patients: What to Expect

At the First-episode and Early Psychosis Program (FEPP) we know from experience that getting you the help you need when psychosis first develops is critical to recovery. Our program offers a variety of services to assist in your recovery process:

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

Before Your Visit

Prior to your first visit we ask that the following items are faxed to the First-episode and Early Psychosis Program:

• A typed summary of your treatment from a psychiatrist or therapist.
• Medical records, including records of past physical exams, blood work and any hospital discharge summaries.
• A copy of any prior neuropsychiatric evaluations and/or educational testing.

All information should be faxed to 617-726-7541 prior to your appointment. Please keep original copies for your own records. This information will be carefully reviewed by a clinician prior to your appointment, which will greatly enhance the quality of your initial evaluation.

At Your First Visit

At your initial visit, you will meet with a member of our clinical team. The clinical team member will ask you questions about your medical history, mental health and medications to determine what treatments would be most beneficial.

After Your Initial Assessment

Based on your initial visit, we will determine what treatment program will best meet your needs. You may be offered ongoing treatment through the First-episode and Early Psychosis Program (FEPP) or you may be directed to other appropriate treatment options.

Some of the treatments available at FEPP include:

• Medication treatment
• Education and family support
• Cognitive behavioral therapy, a form of talk therapy

If you enter the program, program participation is limited to two years. At that point, we will evaluate your need for continued treatment and can assist with a transition to appropriate care.

In Case of Emergency: If you have a psychiatric emergency, please call 911 or go immediately to the closest emergency room for evaluation.

For Families: 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 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
• Communicating effectively with the treatment team
• Supporting independence
• Taking good care of themselves

For Clinicians: What to Expect

We strive to schedule evaluations quickly after we have received a patient's complete clinical information. All second opinion consultations must be initiated by the treating clinician. All patients first undergo a full clinical evaluation by a psychiatrist who presents the information to 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
• Whether our program is the appropriate treatment for the patient
• Which treatments have the best chance of success
• Whether there are community resources that might be helpful adjuncts to treatment

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. Treatment within the First Episode and Early Psychosis Program is limited to two years. At that point, we will evaluate the patient’s need for continued treatment and assist with a transition to appropriate care.

Medication

Our doctors and nurse practitioners aim to prescribe the lowest effective doses and fewest possible 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 regarding medication is strongly encouraged.

We consider not only the psychiatric well-being of patients but also the physical well-being. 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.

Cognitive Behavioral Therapy ("Talk Therapy")

We believe comprehensive treatment includes both medication and therapy. FEPP 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 strategies to help patient’s cope with symptoms and distressing thinking patterns
• Discuss advantages and disadvantages of medication
• Promote well-being and pursuit of life goals

FEPP patients typically attend 16 sessions including three to four sessions of guidance and support for family members during the first six to eight months of treatment.