First episode psychosis patients and Ultra high risk patients in a municipal out-patient clinic by means of Need Adapted and Open Dialogue Approaches

Early psychosis clinic in the Helsinki University Hospital, Finland (catchment area of 570.000 inhabitants) is designed to assess and treat First Episode Psychosis (FEP) patients between 18-40 years of age. Another aim is to... [ view full abstract ]

Early psychosis clinic in the Helsinki University Hospital, Finland (catchment area of 570.000 inhabitants) is designed to assess and treat First Episode Psychosis (FEP) patients between 18-40 years of age. Another aim is to detect young people, who are in Ultra High Risk (UHR) of developing psychosis. We treat approximately 125 FEP-patients in a year.

The main objective is to help patients back on track and to support functioning. The multidisciplinary team consists of 17 mental health professionals. The treatment is organized according to principles of Need Adapted Approach and its modification Open Dialogue (OD). The Approaches have been developed, especially, for the community- based psychiatric treatment.

The main principles of the Need-Adapted Approach emphasize that the therapeutic activities are planned and carried out flexibly and individually in each case so that they meet the changing needs of the patients including the family. The patient’s independence, the sense of agency and grip of life are emphasized in every phase of the treatment process. The principles of the Open Dialogue Approach emphasize immediate help, continual reciprocal dialogue, social network perspective and tolerance of uncertainty.

  In our work, we integrate evidence based interventions in the Approaches (1) Individual cognitive psychotherapy (CBT) interventions (5-25 sessions) aim to reduce the functional impairment and distress caused by hallucinations and distortions in thinking; (2)“Skilled Thinking Group” (TAR) is a group based, computerized Cognitive Remediation Therapy -model assigned to FEP-patients. The goal is to provide a positive learning experience and to promote metacognition and optimal cognitive functioning; (3) Multifamily group. The goal is to use the help of experts by experience, and psychoeducation; and (4) SCIT, a group based treatment model to increase social cognition.