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Early Intervention in Schizophrenia Faculty Research Series January 16, 2013

Early Intervention in Schizophrenia Faculty Research Series January 16, 2013. Professor Alison Yung Institute of Brain Behaviour and Mental Health. Our land abounds in nature’s gifts Of beauty rich and rare. Land of inventions.

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Early Intervention in Schizophrenia Faculty Research Series January 16, 2013

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  1. Early Intervention in SchizophreniaFaculty Research SeriesJanuary 16, 2013 Professor Alison Yung Institute of Brain Behaviour and Mental Health

  2. Our land abounds in nature’s gifts • Of beauty rich and rare

  3. Land of inventions

  4. Early intervention in psychotic disorders such as schizophrenia

  5. Pioneered by Pat McGorry in Melbourne

  6. Early Intervention in Schizophrenia • Rationale • Strategies • Challenges

  7. EI in Schizophrenia: Rationale • Perceptions of schizophrenia

  8. Wikipedia - schizophrenia • is a mental disorder characterized by a breakdown of thought processes and poor emotional responsiveness. • Common symptoms include auditory hallucinations, paranoid or bizarre delusions or disorganised speech and thinking • Accompanied by significant social or occupational dysfunction

  9. Tuscon, Arizona, 2011

  10. Clinicians’ illusion • Health professionals do their psychiatric training in large psychiatric hospitals • Majority of patients seen have chronic schizophrenia and/or acute exacerbations • Impression that this is schizophrenia

  11. But in the beginning..

  12. Functional deterioration • How does schizophrenia develop? • What causes deterioration? • Can deterioration be prevented?

  13. Early intervention - rationale The development of disability and deterioration in functioning often seen in patients with schizophrenia usually occurs early in the course of illness, during the first few years after onset of the first psychotic episode.

  14. functioning critical period 15 - 25 age

  15. “The critical period” – a target for intervention with the aim of preventing or minimising disability.

  16. Causes of early deterioration • Biological • Social • Psychological

  17. Biological causes of early deterioration • Structural and functional brain changes occurring peri-onset eg grey matter loss in frontal and temporal regions • Some may be reversible

  18. Other possible biological causes of deterioration • Substance use • Side effects of medication • Disuse atrophy

  19. Psychological causes of early deterioration • Depression • Demoralisation • Anxiety, fear of relapse • Self-stigmatisation • Loss of identity, hopes and dreams • Post Traumatic Stress Disorder

  20. Social causes of early deterioration • Disruption or loss of peer and family networks • Educational and occupational disruption • Interference with normal development • Homelessness • Stigma

  21. Strategies • Can early intervention prevent deterioration?

  22. Acutetreatment sys Recovery First episodepsychosis DUP Prodrome time

  23. Focus 1: reducing the duration of untreated psychosis (DUP) Acutetreatment sys Recovery First episodepsychosis DUP Prodrome time

  24. Focus 1: reducing the duration of untreated psychosis (DUP) • DUP appears to be both a marker and independent risk factor for poor outcome • Reviews: Marshall et al. 2005; Perkins et al. 2005 • Also confirmed in low and middle income countries (Farooq et al., 2009)

  25. Evidence Bottlender et al 2003 • Longer DUP was associated with higher negative, positive and general symptoms and lower global functioning 15 years after the first psychiatric admission

  26. “Psychosis damages lives” (Lieberman and Fenton, 2000)

  27. There is now evidence that: • 1. It is possible to reduce DUP via a vigorous and sustained public campaign • 2. reducing DUP improves outcome

  28. Reducing duration of untreated psychosis Increase recognition of psychosis and help-seeking Making mental health services accessible

  29. Making mental health services accessible • Friendly to young people • Low stigma • Willing to do home assessments • Flexible eg making allowance for late comers, after hours appointments

  30. Reducing DUP - TIPS • The Early Treatment and Identification of Psychosis (TIPS) study in Scandinavia - Community awareness program and early detection system. • Targeted the general public, schools, primary care • Accessible service • Johanessen, McGlashan, Vaglum, Larsen Melle et al

  31. Reducing DUP improves outcome • Lower negative, depressive and cognitive symptoms at 5 year follow-up • Reduced suicidal behaviour (Melle et al 2009) • Greater social engagement and reduced hospitalisation(Larsen et al 2007)

  32. Reducing DUP improves outcome – persists at 10 yr follow up • Higher rates of remission and recovery (30.7% vs. 13.9% ( p=.01)) • More patients with full-time employment

  33. Acutetreatment sys Recovery First episodepsychosis DUP Non-specific sys Prodrome 1 2 3 4 time

  34. Focus 2: management of first episode psychosis Acutetreatment sys Recovery First episodepsychosis DUP Non-specific sys Prodrome 1 2 3 4 time

  35. Focus 1: management of first episode psychosis • Acute phase • Recovery phase

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