Hospital Clínic of Barcelona, Spain
An update on the psychological treatment for adolescents with early-onset psychosis: Family intervention, metacognitive treatment and cognitive rehabilitation

Olga Puig Navarro. She got a degree in Psychology from the University of Barcelona and Specialist in Clinical Psychology. She received her Ph.D. from the Faculty of Medicine for her doctoral thesis on cognitive rehabilitation in adolescents with early-onset psychotic disorder. She works at the Service of Psychiatry and Psychology of Children and Youth and Hospital Clínic of Barcelona, where she is the chief in the Service of the Program for Specific Care of Early-Onset Psychotic Disorder. She is a member of CIBERSAM (Center for Mental Health Research), and member of a research group of child psychiatry, recognized by the The Government of Catalonia (2014SGR489).

In adult patients with psychotic disorder, the psychological treatment - in combination with pharmacological therapy - is a fundamental part of the therapeutic approach, and it is included in major national and international clinical guidelines. In the case of adolescent patients with early-onset psychotic disorder, clinical guidelines also recommend the combination of pharmacotherapy with psychological intervention, including family intervention and cognitive behavioral therapy (e.g. NICE Guide; CIBERSAM Guide) and cognitive rehabilitation therapy (Guide of the American Association of Child and Adolescent Psychiatry). However, despite these recommendations, dissemination of these interventions in clinical practice is scarce. The objective of the present clinical session is to present, from a clinical and applied perspective, three types of protocols for psychological intervention for adolescents with psychotic disorder, all backed by empirical evidence that supports them as effective treatments. On the one hand, a protocol family intervention for families with adolescents with psychotic disorder (Program PIENSA; in English THINK program), based on a problem-solving approach, will be reviewed. On the other hand, cognitive intervention protocol for patients will be reviewed, according to a meta-cognitive training program based on the model of metacognitive training developed by Steffen Moritz. Finally, we will revise a protocol of neurocognitive intervention to work directly with adolescents, according to the model of cognitive rehabilitation therapy for patients with schizophrenia, adapted to adolescents with early onset of the disorder.


María Mayoral Aragón
Child and Adolescent Psychiatry Department of Adolescent, Hospital General Universitario Gregorio Marañón, School of Psychology, University of Complutense, IiSGM, CIBERSAM. Madrid, Spain.

PIENSA (In English: THINKS) is an assistance program that promotes the treatment of early stages of psychosis onset in adolescence, and research on the effectiveness of psychological therapies in this population. It is located in the Psychiatry Service of Child and Adolescent Psychiatry Department of the Hospital General Universitario Gregorio Marañón (HGUGM) and composed of a multidisciplinary team of health professionals with extensive experience in early-onset psychosis. THINKS includes patients between 14 and 19 years old, of both sexes and whose vulnerability is high due to devastating effect of psychosis at such a young age. The course of childhood-onset psychotic symptoms (as occurs in adult forms) is variable, but in general, its prognosis is worse. In addition, since these disorders appear at a key moment for development, negative impact on functioning is usually higher than when this occurs in adults, and can disturb adolescent development in this important developmental stage. Based on multiple previous studies demonstrating the effectiveness of early intervention in preventing future relapses, the ultimate aim of THINKS is to improve the development and psychosocial adjustment of adolescents who have experienced a first psychotic episode, and promote a better understanding and management of the disease in their families.


Ángel Cabezas Serisa
Early Intervention Service, H.U. Institut Pere Mata, IISPV, URV, CIBERSAM, Reus, Tarragona.
The Metacognitive Training (MCT) of S. Moritz is a structured intervention program including 8 Core Modules (+2 additional), which aims to change the central objective "cognitive infrastructure" of the delusional. The program is translated into different languages, currently applied in different countries, and has shown its effectiveness in psychotic spectrum disorders. The latest version of MCT manual (6.0) does not specify the criteria for inclusion and exclusion the age range, which does not exclude its application in adolescents. However, to date, the literature has focuses on adult populations, with minimum ages of 18 and 20 years. The manual explicitly states that persons who have currently - or in the past - suffered psychotic symptoms are eligible for treatment. During the session the implementation of MCT, which is done in the Early Intervention Team (psychosis) of Reus, patients in early stages of a psychotic disorder, aged between 14 and 35 years old, will be exposed. The assessments carried out within a research project will be explained. Finally, the peculiarities and adaptations arising us in daily practice with adolescent population will be exposed.


Olga Puig
Department of Psychiatry and Psychology with Children and Adolescents. Hospital Clínic of Barcelona. CIBERSAM (2014SGR489).

In recent years, research has shown that much of mental disorders associated with cognitive deficits, being schizophrenia and psychotic disorders diseases the ones with greater evidence of cognitive dysfunction. There has also been growing evidence that cognitive symptoms are not only highly prevalent, but are one of the most important causes of dysfunction in the social functioning of patients, both adults and adolescents with early onset of the disease. The cognitive rehabilitation therapy is a psychological treatment based on the principles of learning that aims to improve cognitive processes such as memory, processing speed, executive functions or care, with the ultimate goal of improving psychosocial functioning in the patients. Today, there are available various cognitive rehabilitation programs that differ in format, duration, presence or not of the therapist, etc. During the session, we revised the programs that have shown greater scientific evidence, with particular emphasis on the intervention protocol Cognitive Remediation Therapy (CRT), one of the protocols of intervention that has more scientific support in general and adolescent patients with early onset of psychosis. Exercises and learning strategies to promote during the intervention will be reviewed with practical examples of the sessions.