NEI Podcast E277 - Shaping Recovery: Early Psychosis Outcomes and Engagement with Dr. Robert Cotes
Mar 11, 2026
Robert O. Cotes, Professor of Psychiatry at Emory and leader of Project ARROW, specializes in early psychosis care. He discusses why the first episode is a critical window, the effects of untreated duration, and varied recovery paths. Conversations cover engaging young people and families, coordinated specialty care principles, measurement-based tracking, and innovations like digital biomarkers and precision approaches.
AI Snips
Chapters
Transcript
Episode notes
Prodrome Signals High But Nonspecific Risk
- The prodrome (attenuated symptoms) is common but nonspecific; clinical high risk yields ~15% conversion at one year and ~19% at two years.
- Most who meet CHR criteria do not convert, so treatment choices must weigh false positives.
Prioritize Goals Over Diagnostic Agreement
- Meet people where they are rather than insisting on DSM labels when awareness is low; focus on goals and functioning to maintain engagement.
- Use meaning-making or tailored psychoeducation instead of pushing diagnostic agreement.
Engage Families With Peer Support And Skills Training
- Involve families with structured support: family peer specialists, NAMI, multifamily groups, and conflict-resolution training.
- Balance hope with realistic expectations and teach boundary setting, especially when substance use complicates care.