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Preventing the First Episode of Psychosis

Preventing the First Episode of Psychosis. William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of Psychosis Program Robert Wood Johnson Foundation Maine Medical Center Research Institute Portland, Maine

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Preventing the First Episode of Psychosis

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  1. Preventing the First Episode of Psychosis William R. McFarlane, M.D., Director, National Program Office Early Detection, Intervention and Prevention of Psychosis Program Robert Wood Johnson Foundation Maine Medical Center Research Institute Portland, Maine Tufts University School of Medicine

  2. Early detection and prevention in another illness “If you catch cancer at Stage 1 or 2, almost everybody lives. If you catch it at Stage 3 or 4, almost everybody dies. We know from cervical cancer that by screening you can reduce cancer up to 70 percent.” ---Lee Hartwell, MD Nobel Laureate, Medicine President and Director, Hutchinson Center New York Times Magazine December 4, 2005, p. 56

  3. 2-3% Proportion of youth who develop schizophrenia or a severe, psychotic mood disorder

  4. 75% Proportion of people who have one psychotic episode and schizophrenia and then develop disability

  5. 12-15% Proportion of people with schizophrenia or a psychotic mood disorder who commit suicide

  6. $61 billion Annual U.S. costs for schizophrenia

  7. Functioning as an effect of number of psychotic episodes

  8. Portland Identification and Early Referral (PIER) Reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment

  9. Professional and public education • Reducing stigma • Increasing understanding of early stages of mental illness and prodromal symptoms • How to get consultation, specialized assessments and treatment quickly

  10. Family practitioners College health services Mental health clinicians Pediatricians Military bases and recruiters EDIPPP Team School teachers, guidance counselors, nurses, social workers Clergy Emergency and crisis services Advertising Employers General Public

  11. Family-aided Assertive Community Treatment (FACT) • In-depth assessment of symptoms of risk • Rapid initiation of treatment • Psychoeducational multifamily groups • Supported employment and education • Key intensive case management methods

  12. Early Detection and Intervention for the Prevention of Psychosis (EDIPPP) A national multisite effectiveness trial Reducing the incidence of major psychotic disorders in a defined population, by early detection and treatment

  13. Early Detection and Intervention for the Prevention of Psychosis • Effectiveness Test at six sites: • Portland, Maine • Glen Oaks and Queens, New York • Ann Arbor, Michigan • Salem, Oregon • Sacramento, California • Albuquerque, New Mexico • Large, nationally representative sample • PIER community outreach and identification systems • Sponsored by RWJF: $17 million

  14. Outcomes

  15. Early identification across cities *Rate for Nottingham, U.K., in Kirkbride, et al., Arch Gen Psychiatry. 2006;63:250-258 ** Proportion (69.2%) of ages 12-35 population represented by ages 12-25 population

  16. Rates of psychosis and negative eventsOver 24 months *Hospitalizations, incarcerations, suicide attempts, assaults, rape

  17. In school or working:Baseline and 24 months

  18. First hospitalizations for psychosisMaine Urban controls areas vs. Greater Portland *p<0.0001

  19. Savings for First Hospital Admissions for PsychosisGreater Portland vs. Urban Maine1999-2000 vs. 2001-2007

  20. Early intervention is preventionOne year rates for conversion to psychosis Risk reduction = 66% 23.0% % Fusar-Poli, et al, JAMA Psychiatry, 2013

  21. Outcomes in First Four California PIER Programs

  22. Conclusions Community-wide education is feasible. Referral of 30% up to 60% of the at-risk population. Global outcome in FACT was better than regular treatment. The rate psychosis onset is less than 1/4 of expected. Average functioning was in the normal range by 24 months. Five cities show a declining incidence. Programs in California are showing same results. ¾ were in school or working up to 10 years later.

  23. Conclusion As in successes for prevention in cancer and cardiovascular disease, early identification and intervention for psychosis give us enormous opportunities to reduce the total burden of disease in the United States.

  24. For further information: www.PIERTrainingInstitute.org PTI@maine.rr.com

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