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First Episode Treatment

Psychosis is a symptom, and is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.

Early or first-episode psychosis refers to when a person first shows signs of losing contact with reality. Connecting a person with the right treatment during early psychosis can alter the course of illness and reduce the risk of long term disability.

Early warning signs before psychosis

Early psychosis rarely appears spontaneously or with rapid onset. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but is unable to identify what is occurring. Early warning signs can be difficult to notice, or to distinguish from typical teen or young adult behavior, and include the following:

  • An unexplained drop in grades or job performance

  • Changes in cognition such as difficulty thinking clearly or concentrating

  • Suspiciousness or uneasiness with others

  • A decline in self-care or personal hygiene

  • Isolating, loss of contact with friends

  • Strong, inappropriate emotions or having no feelings at all

Signs of early or first-episode psychosis


Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:

  • Hearing, seeing, tasting or believing things that others don’t

  • Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe

  • A sense of confusion, difficulty expressing thoughts and ideas in a coherent manner

  • Strong and inappropriate emotions or no emotions at all

  • Withdrawing from family or friends

  • A sudden decline in self-care

  • Trouble thinking clearly or concentrating



Psychosis includes a range of symptoms but typically involves one of these two major experiences:

Hallucinations are seeing, hearing or feeling things that aren’t there, such as the following:

  • Hearing voices, sounds or music (auditory hallucinations)

  • Strange sensations or unexplainable feelings

  • Seeing objects or people that are not there or experiencing perceptual distortions


Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true and may seem irrational to others, such as the following:

  • Believing external forces are controlling thoughts, feelings and behaviors

  • Believing that trivial remarks, events or objects have personal meaning or significance

  • Thinking you have special powers, are on a special mission

  • Believing that others can read your thoughts or are inserting thoughts into your heard

  • Falsely believing that you are in a special or romantic relationship with another person


We are still learning about how and why psychosis develops, but several factors are likely involved, including genetics, trauma, substance abuse, physical injury or illness, and mental illness.



Experiencing changes in behavior and thinking associated with mania and/or psychosis, especially for the first time, can be frightening and can disrupt an individual's ability to participate in relationships and in meaningful activities such as school and work. The entire family system can be thrown into disarray and feel overwhelmed. Individuals suffering from mania or psychosis may worry that they may never recover, will be unable to resume their academic or occupational trajectory, and will have irreparably harmed their relationships.

The Lieber First Episode program is a recovery-oriented program which takes a personalized approach. We seek to identify meaningful, personalized goals, such as a return to school or work, symptom remission, improved cognition, or broadening relationships, and then develop a treatment plan related to those goals which is designed to build skills, resilience, insight, and stoke intrinsic motivation. Individuals in recovery change, and treatment is adjusted to meet an individual's needs at any given time. Individuals attending the Lieber First Episode program may work with one of our psychiatrists or continue with their psychiatrist in the community, with whom we will work collaboratively.

Most of the treatment at the clinic occurs in small groups (4-8 members). Individual services available include supported education and employment (supporting individuals in their return to work or school), and recovery coaching (supporting individuals in managing activities of daily living, commuting, structuring leisure time, managing finances, maintaining the home, etc.). A small number of patients also work individually with one of our CBT for psychosis therapists. All families are invited to an orientation session at the start of treatment. Family therapy and additional psychoeducation groups for parents may also be integrated into an individual's treatment plan. Patients continue to participate in the program for as long as is appropriate and until their goals are met.


A typical First Episode treatment plan includes:

Cognitive Skills Training 

CBT for Psychosis 

Supportive Employment/Education

Social Skills and Social Cognition

Recovery Coaching

Executive Functioning Training

Wellness Recovery Action Planning

Family Psychoeducation and Support

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