How to refer someone to the Nova Scotia Early Psychosis Program

From the Nova Scotia Early Psychosis Program (NSEPP) website:

Because NSEPP is located in Halifax, within the largest of the Nova Scotia health regions; Capital Health, the program provides direct clinical services to residents of the Capital Health district.

Referrals to NSEPP can be made by anyone, including mental health care professionals, family physicians, community agencies, educators and school counselors, family members, friends and any young person who suspects they may be suffering from a first episode of psychosis.

Criteria for referral of individuals who reside in the Capital Health district are:

• Any individual between the ages of 15-35 who is suspected of experiencing or has been diagnosed with a first episode of psychosis, and

• Has been treated for less than 6 months with an anti-psychotic medication, and

• At the time of referral has had active, untreated psychosis for less than one year.

If you or someone you know meets these criteria please contact the NSEPP immediately at (902) 473-2976.

What can I expect if I refer someone who resides in the Capital Health district?

• The intake coordinator from NSEPP will usually contact the person making the referral within 1- 2 working days after NSEPP receives the referral. The purpose of this contact is to obtain information necessary to decide if the person being referred meets the criteria for the NSEPP program and to also determine the urgency of the referral.

• All information regarding new referrals is presented by the intake coordinator to the NSEPP multidisciplinary team at their weekly meeting. At that meeting the NSEPP team will determine if the individual referred meets the criteria for the NSEPP program. If a referral meets criteria, NSEPP endeavours to assess those individuals within 1-2 weeks.

• Priority for appointments for initial assessments will be determined by the NSEPP team based on their assessment of the degree of urgency.

• Urgent referrals are assessed, whenever possible, within 1-2 working days.

• The individual making the referral to the NSEPP will be notified of the date of the assessment appointment and, after the assessment is completed, will be notified of the outcome.

• If it is determined that an individual referred to NSEPP does not meet criteria for the program, the individual making the referral will be notified by the intake coordinator and will be provided with information regarding referral to other appropriate mental health services. 

Under the provincial service delivery model developed by the Nova Scotia Department of Health and as one of the Dalhousie University Department of Psychiatry clinical academic programs, NSEPP provides clinical consultation for residents of the Maritime provinces who reside outside the Capital Health district.

Criteria for referral of individuals who reside in the Maritime Provinces outside of the Capital Health district:

• NSEPP only accepts referrals for consultation from health care professionals including any mental health care professional or family physician, and

• Any individual between the age of 15-35 who is experiencing early psychosis (within the first 5 years of the onset of psychosis), may be referred for a consultation regarding diagnosis and/or treatment.

NSEPP does not provide ongoing clinical services to individuals who reside outside of the Capital Health district.

What can I expect if I refer an individual who resides in the Maritime Provinces outside of the Capital Health district?

• The intake coordinator from NSEPP will usually contact the person making the referral within 1 week after NSEPP receives the referral. The purpose of this contact is to obtain more detailed information regarding the reasons for the referral for consultation from the NSEPP.

• All information regarding consultations is presented by the intake coordinator to the NSEPP multidisciplinary team at their weekly meeting. At that meeting the NSEPP team will determine if the consultation referral to NSEPP meets the program criteria for consultation from NSEPP.

• If a consultation referral meets the NSEPP criteria, the NSEPP endeavours to assess all individuals referred for a consultation within 4 weeks after NSEPP receives the referral

• The individual making the referral to the NSEPP will be notified of the date of the consultation appointment. Once the consultation is completed, the individual making the referral will receive a written report.

• If it is determined that an individual referred to NSEPP does not meet criteria for referral for a consultation from NSEPP the individual making the referral will be notified by the intake coordinator and will be provided with information regarding referral to other appropriate mental health services.

At this time, persons referred for a consultation with the NSEPP must be willing to travel to Halifax/Dartmouth Nova Scotia for an assessment

To make a referral for a consultation please contact (902) 473-2976.

Image credit

Also see:

Nova Scotia Early Psychosis Program - Brochure

Nova Scotia Early Psychosis Program - Website

Nova Scotia Early Psychosis Program - Family Education (PDF)

Mending Minds

Mental health early intervention projects offer 'outstanding value'

Please click on the image to magnify it.

An article posted on April 20th by Children & Young People Now:

Having early intervention psychosis teams work with young people experiencing their first episode of schizophrenia or bipolar disorder can save as much as £18 for every £1 spent.

By Joe Lepper

Taxpayers save £8 for every £1 spent on parenting programmes, according to the latest study into the value of early intervention mental health projects.

The study by the Department of Health, London School of Economics and Political Science, the Centre for Mental Health and Institute of Psychiatry found savings increased as the mental health support became more specialised.

It is estimated that £18 is saved for every £1 spent on deploying early intervention psychosis teams to work with young people experiencing their first episode of schizophrenia or bipolar disorder.

Suicide training for GPs saves £44 and alcohol misuse schemes save £12 for every £1 spent.

Called Mental Health Promotion and Mental Illness Prevention: the Economic Case, the study puts the economic and social cost of mental health problems, through factors such as offending rates and benefit payments, at £105bn a year.

Care services minister Paul Burstow said: "Mental health is not a matter of them and us, it’s about all of us. At some point one in four of us will suffer a mental health problem.

"PCTs and GP Consortia should take a careful look at this study and use it to commission better mental health services."

The research team looked at 15 different mental health projects. Team leader Professor Martin Knapp said they all offer "outstandingly good value for money".

He added: "Most are low in cost and many become self-financing over time, saving public expenditure as well as radically improving the quality of people’s lives."

Also see:

What’s it worth now?

Psychosis - Fact Sheets

From the Early Psychosis Prevention and Intervention Centre:

Fact Sheets

These fact sheets, in English, and 10 linguistically diverse languages, provide information specific to early psychosis. The information is most useful for young people, their family and friends. Anyone can print these fact sheets out and distribute them. The fact sheets provide information about the different types of psychotic disorders, and the phases of assessment, treatment, and recovery.

• What is psychosis?
• Getting help early
• Recovering from psychosis
• How can I help?
  

These information sheets are also available in other languages.

• French
• Arabic
• Croatian
• Greek
• Italian
• Serbian
• Spanish
• Turkish
• Vietnamese
• Simplified Chinese
• Traditional Chinese

Click here to go to the Free Downloads page

McGorry urges mental health overhaul

An article published in today's edition of The Sydney Morning Herald:

By Julia Medew

The Australian of the Year, Patrick McGorry [pictured], has called for a massive overhaul of the mental health system to direct funds away from acute hospital services to more community-based care.

Only weeks after accepting his award, Professor McGorry has moved to capitalise on his role by asking the federal Health Minister, Nicola Roxon, for at least $200 million in new services this year.

On top of his list is a significant expansion of specialised treatment facilities for young people aged 15 to 24 who are experiencing early psychosis and other serious mental health disorders such as schizophrenia.

He said the only such facility in Australia, Orygen Youth Health, should be used as a model for 10 new centres in other cities this year, with a commitment to another 10 in regional hubs over the next five years.

The rollout would cost $100 million this year, he said, with recurrent spending rising to about $250 million a year when all 21 centres are operating.

"This investment will be recouped three times over because early intervention is highly cost-effective and rapidly shrinks the need for care in the medium to long term," he said.

"This will free up resources for the long-term disabled cases and the broader range of mental disorders. The health economics case is unassailable."

Professor McGorry, who directs Orygen Youth Health, said he had also asked for 60 new "headspace" centres, which currently provide mental health, education, employment and drug and alcohol services to young people aged 12 to 25 at 30 sites across the country.

He said this expansion, which would cost $100 million to set up and the same in recurrent spending, would make headspace centres the first port of call for young people showing signs of mental illness, who could then be referred on to the specialised treatment facilities if need be.

"This is a low-risk reform strategy with rapid and dramatic benefits in health gain and cost savings. Failure to invest in early psychosis reform will result in another lost generation of young Australians consigned to unnecessary disability as well as premature death from suicide and cardiovascular disease," he said.

Professor McGorry said he wanted to see the centre of gravity of mental health services shifted away from hospitals to community-based facilities because the sector had suffered enormously from being moved out of "asylums" and into hospitals in the 1990s. He said the transition was like "boarding a sinking ship" for mental health professionals who had struggled to work with scarce funds ever since.

''The acute pressure [on the hospital system] has made mental health budgets very vulnerable,'' he said. ''The mental health system needs to be scaled up significantly now. It needs to double in size and the states can't do it alone.''

Professor McGorry said that after consulting widely in recent weeks, he also hoped federal and state and territory governments would fund more mobile treatment teams for people with delayed recovery and persistent conditions so they were not forced to go to hospital emergency departments during crises.

"We need to disinvest in emergency departments as the place for acute and crisis care. EDs are the wrong places for people with mental health problems to be treated," he said.

Photo credit

Scientists try to stop schizophrenia in its tracks

An article posted on July 26th by ABC News:

Seeking to block voices, 'odd thoughts,' scientists try to stop schizophrenia in young people

By Malcolm Ritter, Associated Press

PORTLAND, Maine — She was sociable and happy in high school. But in college that changed abruptly: Depressed and withdrawn, some days she couldn't get out of bed.

And that wasn't all.

"I had really odd thoughts," recalled the woman, now 21, who asked that her name not be used. While walking across campus at the University of Southern Maine, "sometimes I'd feel like people were just right behind me (who might) jump me or something."

She knew it wasn't true, but she couldn't shake the feeling.

Sometimes, while driving, she saw imaginary, shadowy people on the sidewalk. And now and then, out of nowhere, there would be a woman's voice in her ear during class, or random soft noises like knocking or the fizzy hiss of a newly opened soda can.

When she visited the university health service and talked about feeling depressed, a nurse practitioner saw another problem: a possible case of schizophrenia in the making.

This schizophrenia "prodrome" — the early signs — involves a troubled mental state usually found in teens and young adults. It can lead to psychosis, the loss of touch with reality that marks not only schizophrenia, but also some forms of depression or manic-depression. The prodrome can linger for weeks, or years, before it gives way to psychosis — or mysteriously disappears without a trace.

Researchers have known about this warning phase for decades, but they're still working on how to treat it. Now they're calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who's on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation.

In contrast, people with psychosis firmly cling to unreasonable explanations instead. When someone interprets an odd halo of light over a bedroom doorway as an urgent message from a dead relative, "that's when they have gone over to the psychotic side," said Dr. Thomas McGlashan, a Yale University psychiatry professor.

Some early signs of the prodrome are subtle. "Sometimes kids will (say) light seems different," and windows are too bright, said Ann Lovegren Conley, the family nurse practitioner at USM who spotted apparent prodromal symptoms in the student on her campus.

That can signal "this is not just typical depression or situational stress," Conley said. "There's something more here."

After hearing the student's story, Conley put her in touch with the Portland Identification and Early Referral program, called PIER, one of about 20 clinics in the United States that focus on treating prodrome cases. PIER has trained her and thousands of other school nurses and counselors, pediatricians and others in greater Portland in how to spot them.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition's day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

With a grant from the Robert Wood Johnson Foundation, the PIER approach is also being tried in California, Oregon, Michigan and New York.

Even before treatment begins, a patient's encounter with someone who understands can be dramatic. McGlashan recalled that one young woman at the Yale clinic burst into tears when being asked about symptoms, explaining, "I thought I was the only person in the world who was having these experiences."

Or, when asked if they've felt like the television was speaking to them personally, young clients may reply, "How did you know?" McGlashan said.

Studying the schizophrenia prodrome has been tough for the small but growing group of researchers in the area, because the condition is relatively uncommon. A typical community may get only one new case per 10,000 people each year,* and only a fraction of those people would end up in a research study.

A federally funded project kicked into gear this year to uncover biological signals that will help identify people headed toward psychosis. There's already early evidence, for example, that combining brain scans with a standardized interview can greatly help, said Tyrone Cannon of the University of California, Los Angeles.

Such research should also point the way to better treatments, by exposing the biological roots of psychosis, Cannon said. He's the principal investigator of the project, which is being carried out at several medical centers.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

Low doses of anti-psychotic drugs dampen symptoms. But it's not clear whether those drugs can actually prevent psychosis. Side effects like serious weight gain are a problem, especially since many treated patients would never have developed psychosis anyway. What's more, the weight gain can turn young people away from anti-psychotic drugs, even if they move on to become psychotic and clearly need them.

Researchers are finding promise in psychosocial treatments, like those aimed at helping patients learn to manage stresses in their lives or understand and interpret their symptoms. Efforts to help young people complete their education, hold a job and stay connected to peers will help them avoid unemployment and social isolation later on, whether they progress to psychosis or not, experts say.

In fact, keeping up social contacts may help manage the prodrome. "We're convinced that if they start closeting themselves, coming home after school and just spending time in their bedroom, that will accelerate any process toward psychosis," McGlashan said. "If you dim your social life, it makes it easier for your brain to hallucinate and develop strange ideas."

The PIER program, which began eight years ago, hasn't yet published detailed results on its effectiveness. Its goal is to cut the rate of hospitalizations for first episodes of psychosis in Portland. Dr. William McFarlane, who directs it, says early analyses of the results look promising but that it's too early to draw conclusions.

And results from other locations trying the PIER approach won't be available for a couple of years, says Jane Lowe of the sponsoring Johnson foundation.

Still, in Portland, McFarlane said, "we see kids getting better every day."

One of them was the college student Conley referred. With the help of individual counseling, antidepressants and an anti-schizophrenia drug, "gradually I opened up to people," the young woman said.

She started playing tennis, joined a sorority and began exercising in the school gym. She wasn't sad all the time any more. And she stopped hearing and seeing things that weren't there.

On the Net:

• PIER and similar programs: www.preventmentalillness.org

* This statistic represents 94 people per year in Nova Scotia; not an insignificant number, particularly as it relates to the individuals, families, friends, and coworkers who are affected.

Early and network-oriented care may help adolescents at risk of developing psychosis

A press release posted May 14th by EurekAlert:

Family and network oriented, stress-reducing care improves level of overall functioning and mental health in adolescents at risk of developing psychosis, suggests a recent Finnish study.

Jorvi Early psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital (HUCH), Jorvi Hospital, Finland, is a project with an early intervention team for adolescents at risk of developing first-episode psychosis. As developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis, the intervention is based on the idea of multiprofessional, need-adapted, community-, family- and network-oriented, stress-reducing, overall functioning supporting and low-threshold care.

The JERI team meets with adolescents at ages 12-20 in their natural surroundings, e.g. at school or at home, together with their parents and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. The aim of the team is to recognize potential risk cases and reduce the stress level by family and network intervention.

A follow-up study was performed to test how presented intervention will help adolescents at risk. Data was collected between January 2007 and May 2008. During the intervention, mean scores rose statistically significantly on overall functioning and scores on quality of life, depression, anxiety and pre-psychotic symptoms decreased statistically significantly, showing an improvement in overall functioning and mental health in adolescents at risk of developing first-episode psychosis. Adolescents did not receive other therapy or any antipsychotic medication.

"JERI- intervention seems to improve level of overall functioning and support mental health in adolescents at risk of developing first-episode psychosis, even though further study with larger number of subjects, with a proper control group and with a longer follow-up time is needed", says Dr. Niklas Granö, the leader of the research.

###

Results are published in the journal Early Intervention in Psychiatry.

For further information, please contact:

Niklas Granö, PhD.
E-mail: niklas.grano@hus.fi
Tel. + 358 9 471 83007

Reference:

Niklas Granö, Marjaana Karjalainen, Jukka Anto, Arja Itkonen,Virve Edlund and Mikko Roine: An intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland. Early Intervention in Psychiatry (2009; 3: 94-98)

Landmark Institute of Medicine Report Paves Road to Prevention

An article published in the April 3rd edition of Psychiatric News:

By Mark Moran

American Psychiatric Association (APA) leaders involved with the report say it points to a "paradigm shift" in the way medicine and psychiatry approach mental health and illness in the future.

Prevention of mental illness and promotion of mental health are scientifically feasible, and the time is ripe to transfer the science into practice.

That is the conclusion of a landmark report by the Institute of Medicine (IOM) titled "Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities."

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations—such as children and youth in the child-welfare system—school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations, according to the report.

The report updates a 1994 IOM book, Reducing Risks for Mental Disorders, and focuses attention on the research base and program experience with younger populations that have emerged since that time.

The book-length report includes chapters on (among other subjects) using a developmental framework to guide prevention and promotion; perspectives from developmental neuroscience; preventive intervention research—including family, school, and community interventions; prevention of specific disorders; screening; benefits and costs of prevention; and implementation and dissemination of prevention and promotion practices.

APA leaders are hailing the report saying it points to a paradigm shift in the way psychiatry approaches mental illness in the future.

"Both prevention and psychiatry have always been the stepchildren of medicine," said APA President Nada Stotland, M.D. "It is not as glamorous as open-heart surgery or restoring a brilliant individual with bipolar disorder to her career and family. It is much easier to get credit for fixing something that is broken than for keeping it from breaking in the first place. However, most of the improvements in life span are the result of preventive, rather than treatment, measures—immunizations, pap smears, clean air and water, smoking cessation.

"Most health professionals are unaware of the crucial data in the IOM report," Stotland said. "Now that it has been published, and we know that there are effective ways to prevent psychiatric disorders in children, there is no excuse for our country's continued failure to implement the policies that would protect our children from lifetimes of suffering and disability."

Child psychiatrist William Beardslee, M.D., a member of the IOM committee and chair of APA's Corresponding Committee on Prevention of Mental Disorders and Promotion of Mental Health, echoed Stotland.

"This is a landmark report and deserves to be read with care by every psychiatrist," Beardslee told Psychiatric News. "Psychiatry has an opportunity to provide extraordinary leadership in the prevention of mental illness, and we strongly urge APA and individual psychiatrists to support the report's recommendations."

Those recommendations include a call for a coordinated national strategy originating in the White House for implementing prevention and promotion practices.

The IOM report stated, "The White House should create an ongoing mechanism involving federal agencies, stakeholders (including professional associations), and key researchers to develop and implement a strategic approach to the promotion of mental, emotional, and behavioral health and the prevention of mental, emotional, and behavior disorders and related problem behaviors in young people."

Psychiatrist Carl Bell, M.D., also a member of the IOM committee, said that recommendation was modeled on the success of a similar White House cabinet-level strategy during the Clinton administration concerning violence against women.

"What the IOM is saying is that it is possible to prevent psychiatric disorders, substance abuse, and problem behaviors," Bell told Psychiatric News. "The challenge for psychiatry is to shift its paradigm and stop thinking of itself as a field that only treats the sick, but begins to think in terms of a public-health model."

Beardslee and Bell both stressed that the IOM report underscores the importance—and scientific basis—not only of preventing or preempting the occurrence of major mental disorders among individuals who exhibit preclinical symptoms, but also broad population-based strategies aimed at promoting mental health.

Beardslee stressed as well that in the background of all behavioral disorders are the issues of poverty and health disparities.

"Prevention should be a part of regular psychiatric practice," Beardslee said. "I see three levels at which psychiatrists can be putting prevention into practice. As social scientists, we should be embracing the public-health perspective and broad reforms to address health disparities and poverty. A second level where psychiatrists can have a very large impact is in working with adults with mental illness who have children, doing preventive work using psychoeducational models.

"And the third level is the use of preventive strategies that have been designed for people at very high risk."

Early detection of psychosis – Establishing a service for persons at risk

An abstract published in the January 2009 edition of European Psychiatry:

By Frauke Schultze-Lutter, Stephan Ruhrmann, and Joachim Klosterkötter [pictured]

University of Cologne, Department of Psychiatry and Psychotherapy, Early Recognition and Intervention Centre for Mental Crises (FETZ), 50924 Cologne, Germany

Purpose

The establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.

Method

Across the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.

Results

Rising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.

Conclusion

Supported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.

Keywords: Psychosis; Early detection; Prodrome; Outpatient health services; Program evaluation

To download the entire article, click here (PDF).

Posting of this abstract is for the purposes of research into early psychosis.

Also see:

Early Detection Fact Sheet (PDF)

Nova Scotia Early Psychosis Program

Photograph of Joachim Klosterkötter courtesy of the University of Cologne.

The Staglin Family Announce Largest Ever Grant for Research in Prevention of Mental Disorders at 14th Annual Festival for Mental Health

From the September 15th edition of The Wall Street Journal:

The Pointer Sisters Electrify the Crowd

Chefs Mark Dommen and Todd Humphries Shine on Historic Day


RUTHERFORD, Calif., Sep 15, 2008 (BUSINESS WIRE) -- The 14th Annual Staglin Family Music Festival for Mental Health raised approximately $3 million at its September 13 event to help support pioneering mental health research. Co-hosts Shari and Garen Staglin announced that scientists who have been conducting research with seed funding from previous festival earnings were recently awarded a $21 million grant by the National Institute of Mental Health (NIMH) to begin a large multi-center study. A jubilant mood set in as R&B legends The Pointer Sisters took the stage and enticed guests to hit the dance floor in celebration of the historic day.

Dr. Ty Cannon, PhD, Departments of Psychology and Psychiatry and Biobehavioral Sciences at UCLA helped the Staglins make the historic announcement of the $21 million grant for the North American Prodromal Longitudinal Study (NAPLS). Dr. Cannon has taken a lead in NAPLS, a consortium of eight North American prodromal (an early symptom indicating the onset of an attack or a disease) research centers, which study teens who are at risk for developing psychosis and can be identified and treated before the onset of a full-blown illness. Through this funding, Dr. Cannon is heading a team of scientists and clinicians to develop the means to head off psychosis as a regular clinical intervention, as the effects of an episode produce long-term changes in the brain that are far harder to treat. Currently, their testing has resulted in the ability to identify 40% of at-risk subjects who would develop psychosis before they actually do. This NAPLS grant will allow for further assessment, using an array of biological analyses, with the goal of raising the tests' predictive sensitivity to 80%. This would mean that a full 80% of people who would develop psychosis could be treated early, and, hopefully, be saved from it. The group also aims to uncover the specific neural and molecular changes that drive the emergence of schizophrenia and related illnesses, knowledge that will aid in the development of new approaches to early intervention.

"Funding from the Staglin Music Festival for Mental Health was absolutely instrumental in helping us secure this grant from the NIMH, both through the provision of 'seed' funding for the UCLA early detection of psychosis program and through support of a series of grant planning meetings of the NAPLS investigators," Dr. Cannon stated. "We feel very strongly that, with this major funding, an 80% predictive sensitivity rate is very achievable. This alone can greatly change the way we treat mental illness," Cannon added.

To read the entire article, click here.

reachoutpsychosis.com

Click on the either arrow to start the video.

For more information, visit reachoutpsychosis.com.

Mental Health First Aid

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

To read this article by Anthony F. Jorm, Amy J. Morgan, and Annemarie Wright, click here.

Thanks go to Chris Summerville for bringing this article to my attention.

Also see:
Mental Health First Aid: The ‘Earliest’ Form of Early Intervention for Psychosis (PDF)

Graphic courtesy of the Canadian Mental Health Association- Edmonton Region.

Worsening of Symptoms Prevented by Early Detection

From the July 4th edition of Psychiatric News:

By Mark Moran

Negative symptoms such as cognitive deficits and lack of affect and volition have long been considered unmodifiable and appear to represent core neurobiological deficits of schizophrenia.

Reducing the duration of untreated acute psychosis in first-episode patients appears to prevent the worsening of negative symptoms—such as cognitive deficits and lack of volition, among others—at two-year follow-up.

That finding, from analysis of a public health intervention in Norway, suggests that early identification and treatment of acute psychotic symptoms may affect the core neurobiological deficit process of schizophrenia, and through this alter the course and prognosis for the better.

To read the entire article, click here.

Also see:
Prevention of Negative Symptom Psychopathologies in First-Episode Schizophrenia: Two-Year Effects of Reducing the Duration of Untreated Psychosis.

A disorder in disguise

Poor grades, irritability, suspicion. What distinguishes the beginnings of schizophrenia from normal adolescent turmoil? New research identifies key warning signs, Tralee Pearce reports

To read this article published in the March 25th edition of The Globe and Mail, click here.

Also see:

Scientists Can Predict Psychotic Illness In Up To 80 Percent Of High-risk Youth

Scientists Can Predict Psychotic Illness In Up To 80 Percent Of High-risk Youth

For the full story, click here.

For the abstract of the paper published in the Archives of General Psychiatry, click here.

For a related story published in the February 1st issue of Psychiatric News, click here.

Early detection in psychosis

From the Care Improvement Partnership, National Institute for Mental Health in England. Click here to visit the website.

'Babble test' predicts onset of schizophrenia-spectrum disorders

Source: Reuters Health
Author: Karla Gale
Date: 5 November 2007

In patients with prodromal symptoms of psychosis, extracting spurious phrases from garbled, incomprehensible voices indicates that they are at risk of developing frank schizophrenia-spectrum disorders, according to results of a multicenter study.

In previous research, "we noticed that more extended babble-induced speech illusions were elicited among patients whose illness was recent onset, compared to normal subjects and patients with established, long-standing schizophrenia," Dr. Ralph Hoffman told Reuters Health.

"We subsequently wondered if babble-induced speech illusions might also be a predictor of those high-risk patients who actually go on to develop schizophrenia," he added.

During the 'babble task,' participants listen with headphones to overlapping recordings of six speakers reading neutral texts, the investigators explain in the October issue of the British Journal of Psychiatry. Patients are instructed to repeat words or phrases they believe they hear while listening to the babble, and the number of words is recorded as the length of speech illusion (LSI) score.

Dr. Hoffman, at Yale University in New Haven, Connecticut, and associates tested their theory in a cohort of subjects with prodromal symptoms. Forty-three subjects were tested in the absence of antipsychotic medication, and a subset of the subjects were also tested during treatment with olanzapine for a year.

Twelve converted to a schizophrenia-spectrum disorder.

In the 'no medication state,' the LSI score was significantly associated with subsequent conversion (hazard ratio, 1.78, p = 0.0011). With an LSI cutoff of 4 or above, the positive predictive value was 0.80 and negative predictive value was 0.94 (p = 0.0001).

Dr. Hoffman was careful to preclude any possible clinical recommendations until after their findings are independently replicated. Still, he said, "a test that was established to be predictive at the high rate we found ... could be enormously beneficial."

Data from their preliminary study "suggest that high LSI scores in persons with prodromal symptoms would be an indication to start antipsychotic medication," Dr. Hoffman said. "In contrast, individuals with low LSI scores appear to be at much lower risk," and would not require medication.

Currently, research is dominated by expensive and complex procedures, such as brain scans and neuropsychological testing, he pointed out. "However, I believe that a very careful probing of the positive symptoms of schizophrenia could provide some simple methods for detecting underlying brain changes in their early phase, which could afford a great opportunity to shut down these (psychologically) malignant processes before they take hold."

Deconstructing Schizophrenia Offers Hope for Better Treatment

Click here for the entire story.

For an easier to read PDF of the above poster, click here.

Sixth International Conference on Early Psychosis

Professor Patrick McGorry, IEPA2008 Conference Chair, writes:

Melbourne, Australia is the host city for the 6th International Conference on Early Psychosis. The meeting will bring together the world’s leading experts in early psychosis studies, research and treatments, acting as a forum for ideas to be exchanged, experiences shared, education developed and innovation inspired.

Visitors will find Melbourne an exciting city to explore. It has a reputation for friendly people, a cosmopolitan lifestyle, wonderful shopping and world-class entertainment.

An educational and stimulating program is being developed under the three stages of psychosis and will consist of plenary lectures, break out industry sessions, abstract presentations, a consumer festival and satellite meetings, including the 2008 Australian Schizophrenia Conference. We hope you can participate in the exciting program and look forward to welcoming you to Melbourne, Australia in October 2008.

To visit the IEPA2008 Conference Website, click here.

Thanks go to Dr. David Whitehorn of the Nova Scotia Early Psychosis Program for bringing this conference to my attention.

A parent's question ...

From the July 19th issue of The Times:

How one can distinguish between the slightly aberrant behaviour of many adolescents and the first signs of schizophrenia or allied conditions?

For the full story, click here.

Thanks go to John Devlin for bringing this article to my attention.

Photograph courtesy of The Times.

The Nova Scotia Early Psychosis Program is moving

The following is taken, verbatim, from a bulletin board posting found on May 31st, 2007, in the Purdy Building:

The Nova Scotia Early Psychosis Program is moving ......
(From The Nova Scotia Hospital site)

You have probably heard we are moving! Yes, it's true! Our offices are being relocated to:

The Abbie J. Lane Memorial Building
5909 Veterans' Memorial Lane
Halifax, Nova Scotia
B3H 2E2

There is no definite date yet.
(we expect it will likely occur by September 2007)
When more details are available we will pass them on to you.

We will make every effort to ensure your care is not interrupted, and we will continue to work hard to make sure convenient appointments are made available to you.

If you have any questions, please ask your clinician or call 464-5997