First psychosis programs have been developed during the past 30 years to influence the prognosis of a first psychotic episode by early integrative biopsychosocial interventions, with a focus on the processes that contribute to relapse. In the process of recovery, Navigate program emphasis on enabling a connection to what is important to the person (work, studies, relationships, intimacy), thus strengthening resiliency and quality of life and reducing self-stigma. Medication is part of any intervention program, however, there is a lot of ambivalence amongst the young person and family about its continuation and many will stop the medication altogether. Moreover, although evidence for the benefits of antipsychotic medication in short-term treatment is well established, there is an ongoing debate in the professional medical literature about the need and benefit of routine prophylactic long-term antipsychotics after first psychotic episode. There is also a significant uncertainty concerning the proportion of patients that will maintain remission without antipsychotics.

In this lecture, we will present some of the lessons that we have learned and are still learning from our clients, together with case examples.

In our Navigate Program, we have developed strategies based on literature and experience that enables the person/family to be part of the decision-making process, which at times presents dilemmas and risks but also promotes the potential for growth and transformation.

How do we talk about the medication issue? Who can continue without medication or with very low dosage? How can we taper antipsychotic treatment?

Are we willing to take the risk?

No significant relationships.

To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.

Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.

Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.

The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.