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Early Psychosis Intervention

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					Early Psychosis Intervention
University of Winnipeg January 7, 2004 Sharon Mulder slsm@escape.ca

Learning Objectives
Understanding of psychosis Knowledge of the early indicators of psychosis Knowledge of current treatment approaches Familiarity with the Early Psychosis Prevention and Intervention Service (EPPIS),Winnipeg

WHAT IS PSYCHOSIS? The word psychosis is used to describe conditions which affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this

PSYCHOSIS
Psychosis is a medical condition that affects the brain Psychosis can be treated Psychosis can happen to anyone Symptoms of psychosis most often begin between 16 and 30 years of age Males tend to experience symptoms a few years earlier than females way it is called a psychotic episode.

WHO GETS PSYCHOSIS?
 Approximately 3% of all individuals will experience an episode of psychosis in their lifetime

Approximately 1% will experience schizophrenia Psychosis occurs across all cultures and all levels of socioeconomic status

WARNING SIGNS
SOCIAL Dropping out of activities – or out of life in general Social withdrawal, isolation and reclusiveness Severe deterioration of social relationships Unexpected aggression Suspiciousness

THINKING AND SPEECH
 Irrational statements  Hallucinations  Belief that one possesses special powers  Extreme preoccupation with religion or the occult  Belief that things have changed around them  Memory problems  Peculiar use of words, odd language structures  Severe distractibility

EMOTIONAL
Inability to cry or feel joy, or excessive crying Feelings of depression and anxiety Inappropriate laughter Emotions not in keeping with a situation or thought Euphoric mood

BEHAVIOUR
 Deterioration of personal hygiene  Excessive writing without meaning  Excessive or very diminished energy  Bizarre behaviour  Strange posturing  Severe sleep disturbance  Agitation  Staring without blinking – or blinking incessantly

PERSONALITY
Shift in basic personality Reckless behaviours that are out of character Significantly prolonged decrease in motivation

SYMPTOMS OF PSYCHOSIS
 Delusions  Hallucinations  Disorganized speech  Disorganized behaviour  Restrictions in range & intensity of emotional expression  Restrictions in the fluency and productivity of thought and speech  Restrictions in the initiation of goal-directed behaviour

CAUSES OF PSYCHOSIS
At this time there are many theories about the causes of psychosis, but no certainties. Some of the theories include: Biological Theories Stress Drugs

STRESS-VULNERABILITY MODEL
This model suggests that a vulnerability to psychosis is acquired through a genetic predisposition or as a result of an environmental insult to the brain. The vulnerability must be triggered by environmental stressors. The ‘stress’ component may include: Traumatic life events, use of drugs, stressful living conditions

The rationale behind early identification
Duration of untreated psychosis (DUP) Averages one year Correlates with poorer outcome

These are treatable illnesses
Early identification and intervention leads to better outcomes

Delayed treatment can result in …
           Slower and less complete recovery Interference with psychological and social development Strain on relationships, loss of family and social supports Disruption of parenting role in young mothers/fathers with psychosis Disruption of study or employment Substance abuse Unnecessary hospitalization Depression and suicide Poorer prognosis Increased family strain Increased economic cost to the community

EPIDEMIOLOGY (some rough numbers)
New cases of psychosis  15-20 cases/100,000/year Schizophrenia?  80% of first episode psychosis  12-15 cases/100,000/year  (80-85% have no family history) Others? Mostly bipolar disorder DUP (average) Schizophrenia 1-2 years Psychotic depression 4-5 months Mania – 2 weeks

Elements of a comprehensive early psychosis intervention service
 Timely access to appropriate clinical services Referrals from anyone Assessment within 2 days-2 weeks of referral Appropriate treatment is phase-specific in addressing the needs of the whole person including medication, psychoeducation and psychosocial rehabilitations

 ‘Start low, go slow’ – medications  Emphasis on the symptoms – not diagnosis  Least restrictive environment separate from traditional psychiatric settings  Families are involved from day one  Normalized recovery context  Community outreach and education to facilitate early detection  Ongoing professional development for health care workers

Barriers to accessing care (1)
Social Aspects  Stigma  Individuals are employed or in school and fear a disruption in these aspects  Poor recognition Illness Variables  Decline in cognitive functioning.  Decreased ability to concentrate and remember  Impaired judgement

Barriers to accessing care (2)
Fear of the Unknown  Fear of being admitted to a psychiatric facility  Perception that psychosis is a ‘life sentence’ System Failures  Lack of resources  Poorly defined referral paths  ‘Wait and see’ approach

Secondary Morbidity
Depression Increased risk of suicide Substance abuse Poor social functioning Disruption of personality development

The Manitoba First-Episode Psychosis Family Support Group
Families with young people experiencing first-episode psychosis Free-standing self-help group We meet to: offer support, share information, ensure appropriate services are available in Manitoba for those who need Meet monthly at EPPIS

Family to Family
National newsletter (international) By families – for families Building a network of families across Canada Produced three times yearly Nine issues now available On-line at www.cmha.ca English and French

Early Psychosis Prevention and Intervention Service (EPPIS)
 Announced July 2003  Operational March 2003  Residents of Winnipeg 13-35 years  Anyone can make a referral  Contact within 5-7 days  Not treated for psychosis for more than a month  MATC Broadway and Maryland  Call: 958-9677

Positive Factors in Promoting Recovery
         Strong social support networks Stable living situation Safe and structured environment Sense of purpose or direction; employment or hobbies Someone to discuss experiences and feelings with – provide practical help A good understanding of what has happened Physical well-being Effective medication without distressing side- effects Sense of realistic expectation and HOPE about the future

Untitled
I want to say Goodnight To the darkness And wake lazily To sunshine Licking at my toes Stretching over me And consuming me With heat. I would like To calm The winds of rage Hurling Against the walls Of my mind. For once I would like the silence To overcome The howling Of the storm Inside me. I tell myself One more day One more chore Until I am myself. One more day One more hour One more minute One more second… Of darkness Until the storm breaks And the light of day Shines through. - Tara Marttinen


				
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