Transcript Presentation Slides - IRIS Early Intervention in Psychosis

An Introduction to
Early Intervention
Manchester Mental Health &
Social Care Trust
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Aims & Objectives
To provide an overview of early
intervention for psychosis.
To provide a background to concepts of
early intervention and the phases of a
severe mental illness.
To enable recognition of the signs and
symptoms that might develop in a
young person.
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What is Early Psychosis
Intervention?
Early psychosis intervention refers to the
evidence based approaches used in the
management and treatment of psychosis
The approaches emphasise the importance
of timely interventions which are
individualised, intensive and comprehensive.
Intervention should be appropriate to the
phase of the illness to reduce the likelihood of
further episodes of illness
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What is Early Psychosis
Intervention?
The incidence of first episode psychosis is
estimated to be 15 – 20 cases per 100,000.
Early intervention aims to reduce the duration
of untreated illness which has a positive
outcome in terms of reduction of relapse.
This has been the impetus for the
development of early intervention services
Early interventions have substantially
decreased the need for in-patient care.
(McGorry 1998)
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An Introduction to the
Evidence Base
Schizophrenia and other psychotic
illness can be treated effectively if timely
interventions are delivered in ways that
are acceptable to the people receiving
them.
However, schizophrenia may become a
life long disorder if not treated
appropriately in the early stages.
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An Introduction to the
Evidence Base
The cognitive and psychosocial damage caused by
psychosis appears to occur in the first 5 years, then a
‘plateau of disability’ occurs (Lieberman 1997)
Treating during the ‘critical period’ can decrease
relapse and social disability, limit psychological
problems and reduce healthcare costs (McGorry &
Jackson 1999)
The longer the DUP, the more risk of long-term
problems such as serious physical injury,
unemployment, impoverished social networks, loss of
self esteem ( Jackson & Farmer 1998;Johannessen
2001)
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An Introduction to the
Evidence Base
Morrison et al (2004), in a randomised controlled trial
(RCT) known as the ‘EDIE’ study (Early Detection
and Intervention Evaluation) found that the young
people they studied displayed two distinct subsets of
experiences on entry to their programme:
1. Transient Psychotic Symptoms - ‘Brief Limited
Intermittent Psychotic Symptoms’ (BLIPS). These can
be ‘full-blown’ psychotic symptoms that last for a few
days and then spontaneously resolve
2. ‘Attenuated’ (Subclinical) Psychotic Symptoms
- not severe or disruptive enough to be described as
actual symptoms of psychosis
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Early psychosis -The
Phases of Illness
•
1.
2.
3.
4.
The first episode of psychosis has
been identified as having four
‘phases’:
Prodromal
Acute
Early Recovery
Late Recovery
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Adolescent behaviour
or onset of illness?
In small groups consider all emotions ,
thoughts or behaviours that an
adolescent might experience.
Write these down and share them with
the rest of the group.
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The Prodrome
This is the stage which occurs before the
development of psychotic symptoms
A prodrome is difficult to identify as it is
similar to the stages of adolescence.
This may take on a greater meaning for
others if the person has been identified as
being vulnerable already due to their family or
developmental history.
The person might be distressed at this stage
or show signs of changes in their behaviour.
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The Prodrome
The ‘prodrome’ might be an extended
period lasting for months but this is not
always the case
People presenting with these symptoms
should be monitored within a primary
care setting
(National Collaborating Centre for Mental Health,
2003)
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The signs associated
with a prodrome
A sense of being suspicious or worried
Getting irritable and angry or feeling more tense
than normal especially over trivial things
Experiencing mood swings – feeling low then
feeling very happy
Having problems getting organized and being
unable to establish a routine.
Feeling low or depressed. They may feel a sense
of hopelessness about themselves and the future
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The signs associated
with a prodrome
Changes in sleep pattern – an inability to get
to sleep or waking up early
Changes in appetite or eating habits perhaps feeling a bit suspicious about food
No sense of ‘get up and go’ anymore, a loss
of energy or motivation to do anything
Experiencing difficulty remembering things
such as appointments or practical
arrangements
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The signs associated
with a prodrome
Perceptual changes such as experiencing
an unusual sense of taste, smell or seeing or
hearing things differently
Not going out and becoming social isolated
from friends or family
Feeling anxious about things. This might be in
social environments or going out alone
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Brief Limited Intermittent
Psychotic Episodes ( BLIPS)
 These might be brief episodes of a full
psychotic illness which might involve all the
symptoms of a psychosis but for a brief and
limited period.
 Otherwise these might be similar to psychotic
symptoms but not as intense as a ‘full blown’
psychosis.
 They often occur within the prodrome phase
but they do not necessarily lead to a ‘full
disorder’.
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The Acute Phase
Initially the person might develop ‘attenuated’
positive symptoms.
This phase is characterised by more serious
symptoms such as hearing voices, having
strange or frightening beliefs or experiencing
difficulties with thinking processes.
Sometimes due to the distress involved the
person will refuse help or support.
The goal at this stage is to resolve symptoms
and prevent the establishment of secondary
symptoms
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The Acute Phase
If the person is very disturbed they
might present with behaviour which
might cause them to be at risk to
themselves or others and will need a
risk assessment
An in – patient admission or home
treatment team might be necessary.
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The Signs Associated with
the Acute Phase
Hearing voices when nobody is around
Hearing ones’ own thoughts aloud
Believing objects around the house have
been specially arranged
Thinking that the TV is sending special
messages to the person.
Believing that they are being followed or
someone is attempting to harm them
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The Signs Associated with
the Acute Phase
Believing that people are talking about them
or laughing at them without any evidence to
substantiate that belief
Unusual behaviour such as excessive
checking or wearing unusual clothes,
sunglasses
Staying up all night, pacing around.
These are just a few of the common signs
experienced by people who are in the
acute phases of an illness
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Early Recovery Stage
Often considered to be in the first six months
following treatment
It is during this time that the person is at most
risk of suicide, especially when discharged
from hospital.
It is during this stage that the social,
economic , physical and environmental and
occupational needs should be assessed
Each person will should receive a care plan
and a named care co-ordinator
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Late Recovery Phase
This phase follows the early recovery phase
by a further 12 months
The medication regime to maintain health
should be established
The goal is to promote recovery and avoid
relapse
During this phase the clients should develop
an awareness of the illness and develop skills
to achieve life goals
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Late Recovery Phase
The first five years following a acute episode
is referred to as the ‘critical period’
The risk of relapse is high during the critical
period and occurs in around 80% of those
who have an untreated psychosis.
Maintenance therapy of medication
significantly reduces relapse rates
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Residual symptoms during
the recovery stages
Negative symptoms are often present
following an acute phase.These are generally
the cause of long term disability
People who experience negative symptoms
may talk less spontaneously
The person might be unable to express
themselves and appear to lack emotion
Less energy and loss of motivation is
common
The ability to plan ahead and concentrate
may be compromised
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Residual symptoms during the
recovery stages
The person might continue to maintain
abnormal beliefs or experiences following an
acute episode yet might be less distressed
about them
Secondary symptoms such as depression or
anxiety may develop
Some clients might develop drug or alcohol
problems as they seek a way of coping with
distressing symptoms
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The Stages of Psychosis
In pairs read through the vignettes of
the phases of psychosis
Try to identify the symptoms present
within the case studies and insert them
into the table provided in the handouts
Consider which symptoms are most
characteristic of the different stages of a
psychotic illness
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Conclusion
Early interventions for psychosis aim to
decrease the duration of untreated illness
and to improve outcomes by promoting
recovery and preventing relapse
Four stages have been identified in the
course of psychosis
The prodromal stage is difficult to identify due
to the associated developmental changes of
adolescence
The critical period following an acute phase
needs to be closely monitored as relapse is
common
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