1st Step Program reaching out...staying connected

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1st Step Program reaching out...staying
connected 
Hope and Healing Early Intervention in Psychosis

• CMHC Waterloo, Wellington and Dufferin

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1st 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

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Outline

• What is Psychosis
• Role of Early Intervention
• Case Study and Discussion

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What is Psychosis?
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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

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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

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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.

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• Psychotic Disorders
• Schizophrenia
• Schizoaffective Disorder
• Drug Induced Psychosis
• Organic Psychosis
• Brief Reactive Psychosis

• Mood Disorders
• Bipolar Disorder
• Major Depression
• Post Partum Psychosis

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Phases of Psychosis

• Prodromal things arent 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.

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Early Warning Signs Prodrome

• There may be early warning signs
• social withdrawal
• feeling suspicious
• feeling anxious/irritable
• concentration difficulties
• feeling depressed
• lack of energy

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Acute Phase Signs and Symptoms

• Hallucinations
• Delusions
• Disorganized or confused thinking
• Changes in behaviour
• Changes in mood

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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.

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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

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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.

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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.

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Changes in Mood

• an empty feeling of any emotions with difficulty
  of expression
• inappropriate emotional responses
• sadness, irritability, worry

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Causes of Psychosis

• Exact cause is not known
• Believed to be caused by a chemical imbalance in
  the brain

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Risk Factors

• Genetic (Family History)
• Cannabis and Other Illicit Drugs
• Small increase in risk with birth complications
• Stress school, work, families, relationships,
  immigration

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Early Treatment Hope
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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.
1998172(33)53-9.
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What Does Treatment Mean?

• Medical medication and monitoring
• Psychosocial individual/ group counselling and
  education
• Family support and education
• Community collaboration

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First-Episode Clients Respond Well to Therapy
Initial remission of symptoms at 1 and 2 years
Up to 82
70 to 75
of Clients
Year 1
Year 2
First-episode psychosis (FEP) n 107 Early
Intervention (EI) program
Malla A. Schizophrenia Bulletin. April 2005.
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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

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Complicating Factors During the Critical Period
of Treatment
Poor Insight, Judgment
Complicated, Inconvenient Regimens
Poor Symptom Control
Poor Adherence to Treatment
Substance Abuse
Intolerable Side Effects
Poor Social Support
Oehl M, et al. Acta Psychiatr Scand.
2000102(Suppl. 407)836.
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Case Study

• 17 year old male, Scott
• attending high school, grade 12
• Father took to Emergency for odd behaviour
• Family referral

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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

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Resources

• www.psychosissucks.ca
• www.gethelpearly.ca
• www.cmha.ca

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How to reach us!

• Call our Intake Clinician [phone] ext 738
• We will respond to your call within 24 to 48
  hours (regular business hours)
• The earlier the response, the better the outcome!