Transcript Hope and Healing: Early Intervention in Psychosis

1st Step Program
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Hope and Healing:
Early Intervention in
Psychosis
CMHC: Waterloo, Wellington and Dufferin
st
1
Step Program
• 1 of 27 Early Psychosis Programs in
Ontario
• Operational since October 2007
• Over 100 consumers and their families in
service
• Open referral
• No wait list
• 2 to 5 years recommended service
• Waterloo, Wellington and Dufferin
Outline
What is Psychosis
Role of Early Intervention
Case Study and Discussion
What is Psychosis?
Psychosis is Not
• NOT caused by childhood experiences
• NOT caused by poverty
• NOT caused by bad parenting
• NOT a split personality
• NOT the result of any action or
personal failure by the individual
Facts
• About 1-3 in 100 people will develop
psychosis in their lifetime
• Occurs worldwide regardless of race,
social class, intelligence, culture,
gender or background
• Usually develops between the ages of
16 and 25 years
What is Psychosis?
A complex medical
condition affecting the
brain
Psychosis refers to a loss
of contact with reality, in
which people have
trouble distinguishing
between what is real and
what is not. When this
occurs, it is called a
psychotic episode.
Psychotic Disorders
Mood Disorders
Schizophrenia
Schizoaffective Disorder
Drug Induced Psychosis
Organic Psychosis
Brief Reactive Psychosis
Bipolar Disorder
Major Depression
Post Partum Psychosis
Phases of Psychosis
• Prodromal: things aren’t quite right
• Acute: obvious symptoms of psychosis
• Recovery: reduction in symptoms and a return
to daily function
Psychosis can come on suddenly or very gradually.
Early Warning Signs:
Prodrome
There may be early
warning signs:
 social withdrawal
 feeling suspicious
feeling
anxious/irritable
concentration
difficulties
feeling depressed
lack of energy
Acute Phase:
Signs and Symptoms
–Hallucinations
–Delusions
–Disorganized or confused thinking
–Changes in behaviour
–Changes in mood
Hallucinations
During a psychotic
episode, people may
hear, see, taste or feel
something that is not
actually there. These
changes in perception
are called
hallucinations.
Delusions
• A delusion is a strongly
held beliefs which are
unusual and unjustified.
 Paranoid Delusions
 Delusions of Reference
 Somatic Delusions
 Delusions of Infidelity
 Delusions of Grandeur
Disorganized or Confused
Thinking
• difficulty when trying
•
to concentrate, follow
a conversation or
remember things
thoughts may
become jumbled;
they may not connect
in a way that makes
sense.
Changes in Behaviour
During a psychotic
episode, people
may act very
differently from
how they normally
do. This may be
due to
hallucinations and
delusions.
Changes in Mood
• an empty feeling of
•
•
any emotions with
difficulty of
expression
inappropriate
emotional responses
sadness, irritability,
worry
Causes of Psychosis
• Exact cause is not known
• Believed to be caused by a chemical
imbalance in the brain
Risk Factors
 Genetic (Family History)
 Cannabis and Other Illicit Drugs
 Small increase in risk with birth
complications
 Stress: school, work, families,
relationships, immigration
Early Treatment = Hope
Critical Issues in Treating
Early Psychosis
• The first 2-5 years of the illness are
regarded as the critical period.
• Maximum benefit for long-term
outcome is achieved within the critical
period.
• Clinicians need to be most assertive and
put most of their treatment efforts into
this period.
Birchwood M, et al. British Journal of Psych. 1998;172(33)53-9.
What Does Treatment Mean?
• Medical: medication and
monitoring
• Psychosocial: individual/ group
counselling and education
• Family support and education
• Community collaboration
First-Episode Clients Respond
Well to Therapy
Initial remission of symptoms at 1 and 2 years
100
90
% of Clients
80
70
60
70 to
75%
Up to
82%
50
40
30
20
10
0
Year 1
First-episode psychosis (FEP) n = 107;
Early Intervention (EI) program
Year 2
Malla A. Schizophrenia Bulletin. April 2005.
Early Intervention
• Better outcome
• Full remission
• Lower doses of medication
• Shorter time to remission
• Reduced risk of relapse
• First episode clients who discontinue
medication have a 4X risk of relapse
Complicating Factors During the
Critical Period of Treatment
Poor Insight,
Judgment
Poor Symptom
Control
Complicated,
Inconvenient
Regimens
Poor
Adherence to
Treatment
Intolerable
Side Effects
Substance Abuse
Poor
Social Support
Oehl M, et al. Acta Psychiatr Scand. 2000;102(Suppl. 407):83–6.
Case Study
• 17 year old male, “Scott”
• attending high school, grade 12
• Father took to Emergency for odd
behaviour
• Family referral
Eligibility Criteria
• experienced recent
symptoms of a first
episode of psychosis or
no previous treatment for
recent psychosis
• early psychosis is the
primary issue
• limited contact with the
system (system naïve)
• limited experience with
prescribed medications
(medication naïve)
• resident of Waterloo
Region, Wellington or
Dufferin County
• ages 14 to 35
Resources
• www.psychosissucks.ca
• www.gethelpearly.ca
• www.cmha.ca
How to reach us!
• Call our Intake Clinician: (519) 821 2060
ext 738
• We will respond to your call within 24 to
48 hours (regular business hours)
• The earlier the response, the better the
outcome!