Early Intervention in Psychosis What is psychosis Research

Early Intervention in Psychosis

What is psychosis? • Research has highlighted that psychotic disorders rarely occur suddenly and that psychotic episodes are generally preceded by a gradual change in the person’s well being and psychosocial functioning, often over a period of time • This period, which precedes the onset of full-blown psychotic symptoms, has been called the ‘prodromal’ phase. • It may be possible to prevent psychosis from occurring, or at least reduce the impact it may have on the individual’s life through reducing the duration of untreated psychosis.

Causes of Psychosis • There are many different kinds of psychosis, including depressive psychosis schizophrenia puerperal psychosis bipolar disorder schizophreniform disorder schizoaffective disorder drug induced psychosis organic psychosis • In the last few decades, research has helped us in understanding that this imbalance is most often caused by a combination of genetic vulnerability and environmental vulnerability.

Causes of Psychosis • Environmental Vulnerability- Some types of street drugs can trigger an episode of psychosis. Some drugs like amphetamines and cocaine, can cause drug-induced psychosis.

Causes of Psychosis • Genetic Vulnerability: Since our DNA contains genes which gives our bodies the instructions on how to make proteins, wherever there is a mistake in a gene or mutation, this affect the neurotransmitter to the brain and can cause psychosis which has been linked to the chemical imbalance in the brain. The chances of developing psychosis is believed to be higher for people who have a family member who is affected

Phases of Psychosis There are three phases to a psychotic episode: 1. Prodromal Phase : This is a period before the psychosis became evident and are usually marked by changes in feelings, thoughts and behaviours. Some prodromal symptoms may include; reduction in concentration and attention, sleep disturbance, anxiety, social withdrawal, suspiciousness or depressed mood

Phases of Psychosis contd. 2. Acute Phase : - During the acute phase, typical psychotic symptoms emerge. The symptoms of psychosis are frequently separated into “positive” and “negative’’ categories. The Positive Symptoms includes: Delusions, Hallucinations and Disorganized speech Delusions (e. g. unusual beliefs that are not shared by the majority of society and as such are considered as being out of touch with reality) Hallucinations (e. g. hearing things that other people cannot hear, or seeing things that other people cannot see) Thought insertion (e. g. the person experiences thoughts as being put into their mind by an external source) Thought withdrawal (e. g. the person experiences thoughts as being removed by an external source) Thought broadcast (e. g. the person experiences thoughts as being spoken aloud or heard or read by others) Thought disorder (e. g. incoherent speech, pressure of speech and poverty of content and flight of ideas). Acute phase cont. )

Phases of Psychosis contd. The Negative symptoms includes: • Decrease in or loss of normal functions • Decreased ability to initiate tasks • Low level of motivation or drive • Depression • Suicidal thoughts or behaviour 3. Recovery Phase: The recovery process vary from person to person in duration and degree of functional improvement. Whilst some recover from the psychosis very quickly and be ready to return to life and their responsibilities, others will need longer to respond to treatment and may need time to respond gradually.

Composition of Teams There are two EIIP Teams covering the whole of Surrey and NE Hants. Our operational hours are 9 - 5 pm, Monday to Friday The EIi. P teams are made up of professionals as follows: • Consultant psychiatrists and Specialist doctors • Psychologists • Community Psychiatric Nurses • Occupational Therapists • Social workers • Approved Mental Health Practitioners • Support, Time and Recovery workers • Enabling Independence workers

Purpose of EIi. P Support Our aim is to provide support to young people and their families to reduce Stigma associated with psychosis through early assessment thereby reduce the duration of untreated psychosis or (D. U. P. ) We aim to develop meaningful engagement, increased stability in the lives of service users, facilitate development and help to provide opportunities for personal fulfilment and promote recovery during the early phase of recovery. We provide interventions aimed at specific difficulties such as anxiety, depression or substance misuse and help with interpersonal, vocational and family issues where Psychoeducation and assistance to develop coping strategies for sub threshold psychotic symptoms.

Support Provided by EIi. P We aim to help provide clear information about risks in relation to future mental health issues, delivered in a careful and considered way. The service works closely with partnership services: - • Primary care • Community Mental Health Recovery Services (CMHRS) • Child and Adolescent Mental Health Service (CAMHS) • Universities, Colleges, Schools • Probation services

Support Provided by EIi. P • Medical intervention aiming to provide optimal medical management including pharmacological treatments aimed at minimising side effects and helps in symptom management. • Psychological Support including Psycho-education, cognitive behavioural therapies (CBT) and goal setting • Social aiming to promote inclusion into community environment and provide support with recovery process, practical support with housing needs, benefits, youth & leisure services, Direct payments, • Vocational support as evidence has shown that young people with early onset psychosis benefit from support to continue with their work or education • Family interventions aimed to support service users who have experienced psychosis and significant others in their family to understand what has happened and how they may work at finding practical solutions to day problems In all, our focus lies with promoting a better well being to manage symptom's and be treated hence preventing the acute phases of illness and admissions into hospital

Support Provided by EIi. P Throughout the year, we aim to run various group to support our service users in promoting recovery. These include: • Social group • Social Confidence group • Wellness & Recovery Action Planning (WRAP) group • Recovery Workshop • Carer’s group

Benefits of Treatment • In the prodromal stage, treatment usually ameliorates the presenting prodromal symptoms and the associated distress and risk of self-harm. Most clients are able to continue work or education, or return to this if they have dropped out. In the longer term treatment significantly reduces the risk of the client developing a psychotic illness in the next 2 years to 23%. • In the minority of clients who do become psychotic, the outcome appears to be better than in patients who were not seen prior to the onset of illness. Thus they are less likely to require hospital admission, compulsory treatment, or involvement of the Police, and are more likely to adhere to subsequent treatment.