ABSTRACT
In the real world of working with young people in treatment for schizophrenia for the first time there are individual, institutional and practical concerns that often make treatment complex. Each patient is a unique person and no recovery is the same. Symptoms at first presentation, developmental stage, socioeconomic level, intelligence, cultural and ethnic background, academic accomplishments, work experience, use of substances, history of trauma, duration of untreated psychosis, personal strengths, and family all vary widely. And while most young people we describe have few significant personality problems, some have antisocial, borderline or other difficult personality traits. All of these issues need to be addressed in treatment, even after the remission of symptoms (McGorry, 2005). There are many practical problems that interfere with the ideal treatment plan, such as lack of health benefits, unavailability of families, and inability to get transportation to treatment. Institutions may be unable to provide the many services needed by first-episode patients. For example, in the United States medical coverage often determines the location of treatment, resulting in a dispersion of patients over wide geographical areas so that it is logistically difficult to develop programs or groups for first-episode treatment.
