Download Early Onset Psychosis

Early Psychosis
Eric Tadehara, Utah State Division of Substance Abuse and Mental Health
Jayne Kashiwaeda, Weber Human Services
Dallin, Bruce and Sabrina (mother), Youth and Family Perspective
Objectives of this Presentation
 Why should we pay attention to early psychosis?
 Coordinated Specialty Care (CSC) for first-episode psychosis
 Implementation and intervention strategies
 Personal experience from a young person’s family
Why Should we Pay Attention to Early
Psychosis?
Schizophrenia and other disorders involving psychosis are among the most
debilitating mental health conditions among youth and young adults
Individuals who experience earlier onset of first episode psychosis are at a
greater risk for negative outcomes as compared to individuals who
experience their first episode later in life:
 Increased suicide attempts
(Sanchez-Gitstau et al., 2013)
 Poor academic achievement (Paya et al., 2013)
 Increased Engagement in substance use (Schimmelmann, Conus, Cotton,
Kupferschmid, McGorry, & Lambert, 2013)
Appropriate early intervention (within 2-3 years of first episode) can reduce
symptom relapse by up to 50%
What is the most Common age of
Onset?
 Each year, ~100,000 young people in the U.S. experience a first episode of
psychosis.
 20 years of age, however there are children and youth who experience
their first episode of psychosis at a much earlier age (between 15 and 25).
 Those who experience their first episode of psychosis prior to their early 20s
are considered to be experiencing “early onset” psychosis.
 Research is ongoing to understand what symptoms may be identified in the
prodromal phase that predict onset (Addington et al., 2015).
Warning Signs
 Withdrawing; Spending more time alone/isolated
 A drop in grades or overall performance
 Trouble thinking clearly or concentrating
 Suspiciousness or uneasiness with others
 Decline in self-care or hygiene
 Strong, often inappropriate emotions or having no feelings at all
Symptoms and Other Warning Signs
 Hallucinations (e.g. hearing voices, seeing things that are not there)
 Delusions (e.g. suspicious thoughts, believing one has superpowers)
 Disorganized thoughts (e.g. difficulty thinking, rapidly changing thoughts)
NAMI Survey on First Episode Psychosis
 NAMI conducted a survey in 2008 which found that an average nine year
gap occurs between symptoms and the beginning of treatment.
 In 2011 NAMI conducted a survey of Individuals who have experienced
psychosis firsthand or directly witnessed by family or friends.
Goal of survey was to identify needs
 Insight into Symptoms
 Most Helpful Persons
Insight into Symptoms
 40% of Individuals reported initial insight came from themselves, and
18% reported family and friends identified symptoms first.
 50% Family/friends reported initial insight came from family and only
13% said the individual recognized their symptoms first.
NAMI suggests, this disparity may illustrate the complexity of recognizing
symptoms and the challenge of discussing them openly
Who was Most Helpful?
Both Individuals and Families: Greatest proportion of responses (22%, 21%
respectively) where, “No one”
 For Individuals, followed by parents, psychiatrists, therapist, spouse, friends.
 For Families, followed by psychiatrist, therapist, spouse, friend.
 For Individuals, high school/college counselors
NAMI suggest these results may indicate a high level of isolation and desperation.
People may not know where to turn, and People who want to help may not know
what to do.
Coordinated Specialty Care (CSC)
Common Elements
 Early intervention
 Team based approach
Team leadership (LMHT, Ph.D.)
Case Management
Supported Employment and Education (SEE)
Psychotherapy
Family education and support
Pharmacotherapy and primary care coordination
Coordinated Specialty Care
continued
Community Based Outreach Team Approach
 24 hours/daily availability
 Team is primary provider of services and fixed point of responsibility
 Majority of services are provided in clients own residence or neighborhood
 Services are highly individualized based on each clients needs
 The assertive team approach and involvement with the client allows the
team to respond proactively to promote recovery, maintain engagement,
and prevent decompensation.
Utah’s Pilot Programs
What we had:
 No screening tool, no outreach, no point of contact on early psychosis interventions
What we added:
 Screening to youth 10 years and older, treatment to the unfunded (including
medication management), outreach to Weber/Morgan Counties and beyond our
catchment area, point of contact for statewide screening/evaluations
Staff Training Needed
 Psychoeducational Multi-Family Group Therapy/Coordinated Specialty Care, PQ-B
(Prodromal Questionnaire-Brief) and SIPS (Structured Interview for Psychosis-risk
Syndrome)
What young people had said to be most helpful for them
 Like the group environment, learn from others, don’t feel so different, educated
parents, better relationships
What is the most difficult component to implement?
 Outreach/engaging community partners in the process
Treatment Perspective & Questions:
from Dallin, Bruce and his mother,
Sabrina
Questions
References
 Addington, J., Liu, L., Buchy, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B.A, . . .
& McGlashan, T. H. (2015) North American Prodrome Longitudinal Study (NAPLS 2): The
Prodromal Symptoms. The Journal of Nervous and Mental Disease, 203(5), 328-35.
 Clemensen, L., Vernal, D. L., & Steinhausen, H-C. (2012). A systematic review of the longterm outcome of early onset schizophrenia. BMC Psychiatry, 12, 150.
 Kessler, R. C., Amminger, G. P., Aguilar-Gaixola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007).
Age of onset of mental disorders: A review of recent literature. Current Opinion in
Psychiatry, 20(4), 359-364.
 Payá, B., Rodríguez-Sánchez, J. M., Otero, S., Muñoz, P., Castro-Fornieles, J., Parellada, M., .
. . Arango, C. (2013). Premorbid impairments in early-onset psychosis: Differences between
patients with schizophrenia and bipolar disorder. Schizophrenia Research, 146, 103–110.
 Sánchez-Gistau, V., Baeza, I., Arango, C., González-Pinto, A., de la Serna, E., Parellada, M.,
. . . Castro-Fornieles, J. (2013). Predictors of suicide attempt in early-onset, first-episode
psychoses: A longitudinal 24-month follow-up study. The Journal of Clinical
Psychiatry, 74(1), 59–66.
 Schimmelmann, B. G., Conus, P., Cotton, S., Kupferschmid, S., McGorry, P. D., & Lambert,
M. (2012). Prevalence and impact of cannabis use disorders in adolescents with early
onset first episode psychosis. European Psychiatry, 27, 463–469.
 NAMI First Episode: Psychosis (2011)
 NAMI Schizophrenia: Public Attitudes, Personal Needs (2008)