Clinical Practice

  • 'Addressing barriers to engagement - Working with challenging behaviour'

    There is no universal definition of challenging behaviour, this is partly because whether or not a behaviour is seen to be ‘challenging’ is subjective. Whether a person perceives a young person’s behaviour to be challenging depends on many factors. These may include their social and cultural background,1 role (e.g. a clinician, teacher), previous exposure to the behaviour, relationship with the young person, confidence in their ability to respond in an appropriate way, available support (e.g. clinical management), and the context in which the behaviour presents (e.g. a classroom, an inpatient unit). It is also important to consider whether or not a behaviour is developmentally appropriate.

  • 'Australian Clinical Guidelines for Early Psychosis - Second Edition Updated'

    The Australian Clinical Guidelines for Early Psychosis were developed in response to growing research and clinical interest in a model of psychosis that challenged the pessimism prevailing at the time regarding the prognosis of people with psychosis. The model presented in these guidelines advocates that young people should receive timely and comprehensive intervention during the critical years following onset, and that ‘withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care’.

  • 'Assessing and managing risk of violence in early psychosis'

    The overwhelming majority (approximately 90%) of people who experience mental ill‑health are not violent. Nonetheless, the rates of general violence in people with psychosis are estimated to be 4–5 times higher than the general population. Since rates of offending in the general community are highest during adolescence and early adulthood, young people with early psychosis may be particularly at risk of violence or offending. However, these risks can be reduced and effectively managed in treatment by targeting relevant risk and protective factors.

  • 'How to screen and intervene for positive cardiometabolic health'

    People with psychosis face a reduction in life expectancy of up to 20 years compared with the general population. This gap is largely due to physical health conditions, such as cardiovascular disease, rather than suicide, and it is widening. Poor cardiometabolic health is prevalent among people with schizophrenia, and is a result of a mixture of factors, including side effects of medication, lifestyle-related factors such as poorer diet, higher smoking rates and reduced physical activity, and wider socioeconomic factors that are associated with psychosis, such as poverty, poorer access to health care, social isolation and marginalisation.

  • 'Managing incomplete recovery in first episode psychosis'

    While the vast majority of young people who develop a first episode of psychosis respond well to initial treatment and have a remission of their symptoms, some young people will continue to experience symptoms and thus show signs of early treatment resistance. Because early treatment response is thought to be one of the strongest predictors of subsequent outcome, preventing enduring symptoms of psychosis and associated impaired social functioning should be the primary aim of treatment for first episode psychosis (FEP).

  • 'Managing transitions in care for young people with early psychosis'

    Changes in a young person’s care can be confusing, disruptive and may require extra practical support for the young person and their family. Perhaps related to these factors, transitions in care also represent a period of increased risk for young people with early psychosis, including risk of suicide and risk of disengagement and therefore relapse and associated decline in functioning.

  • 'Preventing relapse in first episode psychosis'

    Managing and minimising the impact of relapse is an important component of treatment in first episode psychosis (FEP). Between 55–70% of people with FEP will experience a psychotic relapse within two years of remission of their initial episode. With each relapse, recovery becomes difficult and prolonged for the young person, and the risk of chronic or persistent symptoms increases.

  • 'Promoting sexual health'

    Adolescence is a key stage of physical, emotional and social development, when young people transition from childhood, mature physically, and begin to develop adult identities and behaviour. The key challenges of adolescence include more than just the physical changes of puberty; young people also begin in this stage to develop a sense independence, personal identity, healthy values and attitudes and a strong social support network. Sexual health, sexual identity and sexual behaviour are all key parts of every person’s life and personal development.

  • 'Shared decision making'

    The active involvement of people in making decisions about their own treatment is increasingly being viewed as an ethical imperative in all areas of health care, including youth mental health. Shared decision making is a semi-structured process that can promote such involvement. Yet it is often misperceived as simple ‘collaboration’. Some may view shared decision making as a time-consuming, unrealistic ideal, believing there is no benefit to be gained by implementing a more structured clinical approach.

  • 'Working with clinical complexity and challenges in engagement'

    Engagement is fundamental to successfully treating early psychosis. If a young person is well engaged with their treatment, they are more likely to attend services, participate meaningfully in therapy and adhere to medication, all of which increase their chances of recovery. Unfortunately, engagement is not always straightforward, and up to a third of young people may disengage from early psychosis services in the long term.