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

Evidence That Familial Liability for Psychosis Is Expressed as Differential Sensitivity to Cannabis

The abstract of a paper posted online on October 4th by the journal Archives of General Psychiatry:

An Analysis of Patient-Sibling and Sibling-Control Pairs

By Genetic Risk and Outcome in Psychosis (GROUP) Investigators

Context

Individual differences in cannabis sensitivity may be associated with genetic risk for psychotic disorder.

Objectives

To demonstrate and replicate, using 2 conceptually different genetic epidemiological designs, that (familial) liability to psychosis is associated with sensitivity to cannabis.

Design, Setting, and Participants

Sibling-control and cross-sibling comparisons using samples of patients with a psychotic disorder (n = 1120), their siblings (n = 1057), and community controls (n = 590) in the Netherlands and Flanders.

Main Outcome Measures

Positive and negative schizotypy using the Structured Interview for Schizotypy–Revised (for siblings and controls) and self-reported positive and negative psychotic experiences using the Community Assessment of Psychic Experiences (for siblings and patients). Cannabis use was assessed as current use (by urinalysis) and lifetime frequency of use (by Composite International Diagnostic Interview).

Results

In the sibling-control comparison, siblings displayed more than 15 times greater sensitivity to positive schizotypy associated with particularly current cannabis use by urinalysis (adjusted B = 0.197, P < .001) than controls (adjusted B = 0.013, P = .86) (P interaction = .04) and a similar difference in sensitivity to its effect on negative schizotypy (siblings: adjusted B = 0.120, P < .001; controls: B = –0.008, P = .87; P interaction = .03). Similarly, siblings exposed to cannabis resembled their patient relative nearly 10 times more closely in the positive psychotic dimension of the Community Assessment of Psychic Experiences (adjusted B = 0.278, P < .001) compared with nonexposed siblings (adjusted B = 0.025, P = .12) (P interaction < .001). No significant effect was apparent for the Community Assessment of Psychic Experiences negative domain, although the association was directionally similar (2 times more resemblance; P interaction = .17). Cross-sibling, cross-trait analyses suggested that the mechanism underlying these findings was moderation (familial risk increasing sensitivity to cannabis) rather than mediation (familial risk increasing use of cannabis).

Conclusions

Genetic risk for psychotic disorder may be expressed in part as sensitivity to the psychotomimetic effect of cannabis. Cannabis use may synergistically combine with preexisting psychosis liability to cause positive and negative symptoms of psychosis.

Author Affiliations:

René S. Kahn MD, PhD, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands; Don H.Linszen MD, PhD, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Jim van Os MD, PhD, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, the Netherlands, and King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom; Durk Wiersma PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Richard Bruggeman MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen; Wiepke Cahn MD, PhD, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht; Lieuwe de Haan MD, PhD, Department of Psychiatry, Academic Medical Centre, University of Amsterdam; Lydia Krabbendam PhD, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre; and Inez Myin-Germeys PhD, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre.

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

Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001—05: an epidemiological survey

The abstract of an article published in the June 13th, 2009, edition of The Lancet:

By Prof. Michael R. Phillips, MD; Prof. Jingxuan Zhang, MMed; Qichang Shi, BMed; Zhiqiang Song, BMed; Zhijie Ding, BMed; Shutao Pang, MMed; Xianyun Li, MMed; Yali Zhang, MD; and Zhiqing Wang, BMed

Background

In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China.

Methods

We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16 577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist.

Findings

The adjusted 1-month prevalence of any mental disorder was 17·5% (95% CI 16·6—18·5). The prevalence of mood disorders was 6·1% (5·7—6·6), anxiety disorders was 5·6% (5·0—6·3), substance abuse disorders was 5·9% (5·3—6·5), and psychotic disorders was 1·0% (0·8—1·1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional.

Interpretation

Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services.

Funding

China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.

Bold emphasis in the text of the abstract is mine.

Posting of this abstract on the weblog is for the purposes of research into the prevalence and treatment of mental disorders in China.

Also see:

Mental disorders in China underestimated

Psychosis, Ordinary Thinking Not Distant Relatives

The community buffers a variety of aberrant beliefs along the continuum from "normal" to psychosis, but a catastrophic disruption may occur that results in serious mental illness.

To read this article by Mark Moran in the December 7th issue of Psychiatric News, click here.

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.

Sympathy Through Technology

Virtual Reality Experience Mimics Schizophrenia to Teach Health Professionals About Their Patients

The virtual reality simulator Mindstorm lets viewers experience the world through the mind of an individual living with untreated schizophrenia.

For the full story from ABC News, click here.

Surprising Number of People Show Signs of Psychosis

Joan Arehart-Treichel writes in the June 1st edition of Psychiatric News:

Researchers have long known that substantial proportions of nonclinical populations have sub-threshold manifestations of depression and phobia. It is striking to find that the same is true for psychotic experiences.

For more information, click here.

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

Symptoms of Psychosis

Janssen-Ortho has produced an excellent one-page summary of the symptoms of psychosis. To access a copy, click here (opens a PDF file).

Schizophrenia and Psychosis - Early Intervention

Early Intervention in Schizophrenia: What You and Your Family Should Know. This 32 minute video covers the common questions that families have when a person is showing early signs of psychosis or schizophrenia and they begin treatment. Additionally, a young man describes the first symptoms that he experienced when he began to experience psychosis. This video was produced in 2004 by the Maine Medical Center PIER program - for more information go to: www.preventmentalillness.org and for more information on schizophrenia visit www.schizophrenia.com.

Etiologies of Psychosis in Schizophrenia

Click on the image for a larger view.

Reference: Neuroprotection Schizophrenia