Psychotic Disorders

Early Intervention Key in Psychosis Program

By Pauline Anderson
The Medical Post, September 24, 1996

LONDON, ONT. - A unique new early-intervention program at the London Health Sciences Centre here could significantly improve the outcome of adolescents suffering first episode psychosis.

Rather than wait until a crisis develops or police are called upon, the project aims to identify those at risk for psychosis at an earlier stage, thus offering them a better chance at recovery.

"Our main aim in the long run is to see a much better outcome with disorders such as schizophrenia, schizoaffective psychosis, or even bipolar manic depressive psychosis, than is currently the case," said Dr. Ashok Malla, professor and director of research, department of psychiatry, University of Western Ontario, and director, schizophrenia program, London Health Sciences Centre.

The ambitious program, headed by Dr. Malla, involves raising awareness among doctors, parents, teachers and the public, and offering ready access to prompt assessments and interventions where required.

Currently, patients on average have been psychotic for 18 months before being properly diagnosed, which, said Dr. Malla "is a very long period of time."

During that time, brain deterioration can occur which may be irreversible, he said. "Most of the deterioration in schizophrenia -- the cognitive, intellectual sort of deterioration -- occurs within the first two to five years. That means that if we don't intervene early enough, what we're able to achieve is relatively limited."

Melbourne, Australia

Studies show that early intervention can prevent this deterioration and lead to a better long-term outcome. About 90% of patients achieve an almost complete recovery if treated properly during the first episode, compared to only about 70% when treated during a second or third episode, said Dr. Malla. He's aware of only one other program -- in Melbourne, Australia -- that offers a similar early intervention strategy.

This approach requires lower doses of medication. The new program is an "excellent opportunity" to monitor outcomes with new and emerging schizophrenia drugs, said Dr. Malla.

Early interventions, which can include cognitive and behavioral therapies as well as drugs, may also result in improved developmental skills and teenagers staying in school longer, he said.

If the Melbourne example holds true in London, up to 60% of these young psychotic patients can be treated as outpatients, perhaps leading to significant health care savings, he added.

Part of the program involves raising awareness among family physicians who are often the first contact of a patient suffering psychosis. The intervention team plans to use video presentations and other educational strategies, said Dr. Malla, who has a cross appointment in the department of family medicine at UWO.

The program also involves public forums and outreach into high schools and colleges, where the team will offer information sessions on how to recognize early signs of psychosis. "We can make people aware that certain groups are at high risk," said Dr. Malla, adding that as well as young people aged 16 to 25, those at high risk for psychosis also include youngsters with attention deficit disorders, a family history of mental illness and drug use.

Drugs and excessive use of alcohol, said Dr. Malla, often "trigger" psychosis in vulnerable individuals. "In the last two years, I don't think I've seen a young person with psychosis where the psychosis wasn't triggered by some drug use."

There's some evidence that vulnerable adolescents drift to drugs partly as a means of coping with early symptoms of psychosis, said Dr. Malla. The drug use may mask the underlying problem, thereby delaying adequate treatment, he said.

"People may brush this off as a drug problem and not a serious mental health problem."

Doctors, teachers, parents and others should be "sensitized" to look for the sometimes prolonged duration of symptoms that lead up to the actual psychotic episode. These symptoms could include depression, anxiety, withdrawal, unusual concerns about bodily functions and sudden deterioration in school performance.

The team, which includes three psychiatrists as well as other health professionals, will complete an assessment with minimal waits. Dr. Malla estimates the team can handle 100 to 150 new cases per year.

Copyright 1996 Maclean Hunter Publishing Limited
Reprinted with permission.

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