Healing Minds. Changing Attitudes. “First Episode Psychosis”


HELLO AND WELLCOME. I’M PAMELA SMITH. WE’RE GOING TO TAKE A LOOK AT FIRST EPISODE PSYCHOSIS ALSO REFERRED TO FEP. JOINING ME FOR THIS IMPORTANT DISCUSSION DOCTOR ROWLAND IRWIN. LISA — TONY — ALSO DOCTOR JUSTIN POWELL. THANK YOU ALL VERY MUCH FOR JOINING US FOR THIS IMPORTANT CONTINUATION OF A DISCUSSION THAT WE BEGAN TALKING ABOUT IN THE FALL. DOCTOR IRWIN REMIND OUR VIEWERS OF WHAT PSYCHOSIS IS. IT’S A GENERAL TERM THAT REFERRED TO A COLLECTION OF SYMPTOMS IN A DISORDER. THEY GET TO A POINT WHERE THEY CAN’T DISTINGUISH WHAT IS REAL AND NOT REAL. THEY MIGHT HAVE BELIEFS THAT AREN’T TRUE, DELUSIONS. THEY MIGHT THINK THAT PEOPLE CAN HEAR THEIR THOUGHTS. WHEN WE HEAR ABOUT FIRST EPISODES TALK ABOUT THE DISTINCTION, WHY IS THAT TERM COMMONLY USED NOW? THAT’S WHAT IT REFERS TO THE FIRST TIME THAT SOMEONE EXPERIENCES THEIR FIRST SYMPTOMS. WITHDRAWS, DELUSIONS. IF THEY GET TREATMENT QUICKER THE PRONOTICE IS MUCH BETTER. PRIMARILY A TRIGGERING EVENT, A LIFE TRANSITION, THEY’RE GRADUATING, GETTING A JOB, GETTING MARRIED. IT CAN TRIGGER THE FIRST SYMPTOMS. RECOGNIZING THE SYMPTOMS SOON AND QUICKLY WOULD HELP THEM PROGRESS AND DO MUCH BETTER IN TREATMENT. SURE. THE DISTINCTION IS THAT WE’RE CATCHING IT EARLY. THE SYMPTOMS CAN BE — REDUCE THE DISABILITY. NOT CATCHING IT EARLY CAN LEAD TO MORE SEVERE DISABILITY. REALLY CATCHING IT EARLY AND GETTING THEM BACK TO SCHOOL, BACK TO WORK BACK TO LIFE. I CAN’T REMEMBER WHICH ONE OF YOU, IT MIGHT HAVE BEEN YOU DOCTOR POWELL, YOU WERE TALKING ABOUT THE AGE TO IDENTIFY WHEN SOMEONE IS HAVING AN EPISODE. LIKE YOU SAID EARLY ADOLESCENT. AGES 18 TO 22. SOME OF THE WARNING SIGNS, EARLY SYMPTOMS WE TALKED ABOUT WAS SOCIAL WITHDRAWAL. DECLINE ON THEIR ROLE FUNCTION. LIKE IF THEY’RE IN THE MIDDLE OF COLLEGE AND — THERE IS SOMETHING DIFFERENT, THEY’RE NOT DOING AS WELL AS THEY WERE DOING BEFORE. THEY’RE WITHDRAWN. OR THEY MIGHT BE DISPLAYING WHAT WE CALL SUSPICIOUS OF OTHERS. SORT OF PARANOID. A LITTLE MORE IRRITABLE THAN USUAL. WHEN YOU GET THEM TO TRY TO EXPLAIN WHAT IS GOING ON AND THEIR EXPLANATION DIDN’T FIT. WHAT I’M HEARING FROM YOU SOUNDS LIKE IT COULD — HOW DO YOU KNOW WHAT THE DISTINCTION IS? IT’S IMPORTANT TO GET HELP AND IF YOU — RECOGNIZES THAT THEY’RE HAVING THESE TYPES OF BEHAVIORS, THAT IT’S NOT JUST A TEENAGE OR, AN ADULT PHASE. GETTING THEM TO SEE A PROFESSIONAL QUICKLY. SPEAKING OF GETTING THEM INTO PROFESSIONALS, WE TALKED ABOUT THE WORK IN ARKANSAS. I GUESS WE BEGAN — ACROSS THE MENTAL HEALTH CENTERS ACROSS ARKANSAS, IDENTIFY FIRST EPISODE SIGH — WE HAVE TAKEN A NUMBER OF OUR STAFF AT EACH OF OUR CENTERS THROUGH TRAINING OPPORTUNITIES THAT HAVE BEEN VERY GOOD. YOU CAN TALK ABOUT WHAT SOME OF THOSE TRAINING WERE. THE TWO DAY TRAINING ON FAMILY EDUCATION. IT’S DELIVERED TO THE FIRST EPISODE PSYCHOSIS. IT GIVES A SPECIFIC WAY OF ENGAGING THE FAMILY AND CLIENT. BRINGING THEM INTO THE CLINIC. HOW TO KEEP SOMEONE WHO DOESN’T WANT TO ENGAGE WITH CLINICIANS AND DOCTORS. WE HAVE BEEN THROUGH THAT TRAINING AS WELL AS OTHER INDIVIDUAL TYPE INTERVENTIONS. RESILIENCY TRAINING. SO IT SOUNDS LIKE YOU TRIED TO DO A CONCENTRATED OUT REACH HE HAVE OR THE. YEAH. HOW TO PROVIDE SERVICES TO THIS POPULATION THAT IS A LITTLE BIT DIFFICULT TO TREAT AND ALSO HELP THE COMMUNITY IDENTIFY — TO FINE OUT WHAT IS GOING ON AND FIND OUT WHAT THE NEXT STEP IS. I WANT SOMEONE TO EXPLAIN WHY THIS POPULATION MAYBE DIFFICULT TO TREAT. DOCTOR POWELL? A LOT OF PEOPLE DON’T KNOW ABOUT SCHIZOPHRENIA AS THEY KNOW ABOUT DEPRESSION AND ANXIETY. IT’S MORE RARE, BUT IT’S A SERIOUS ILLNESS. THEY MIGHT NOT HAVE MUCH EXPERIENCE WILL THE ILLNESS. IT’S A HARD ILLNESS TO UNDERSTAND. EVEN AFTER THEY HAVE THEIR FIRST SYMPTOM THEIR FAMILY MIGHT GET THEM INTO THE HOSPITAL FOR TREATMENTS. ONCE THEY GET ON MEDICATION THAT HELPS THE PARANOIA, IF THEY HAVE MEDICINE THAT HELPS THESE SYMPTOMS GO AWAY, THEY MIGHT THINK THEY ARE CURED. IT’S EXTREMELY IMPORTANT THAT THEY CONTINUE MEDICATIONS BECAUSE THE MORE PSYCHOTIC EPISODES THAT WE CAN PREVENT, THE MORE HEALTHY IT IS FOR THE BRAIN. IF WE CAN PREVENT THOSE SYMPTOMS, WE CAN PRESERVE A HIGHER LEVEL OF FUNCTIONING. IN ADDITION TO TAKING THE MEDICATION, I WANTED TO ASK YOU A QUESTION RELATED TO NOT TAKING THE MEDICATION, PEOPLE ARE FEELING THAT THEY’RE BETTER AND DON’T NEED IT ANY MORE. IS THERE A CHANCE THAT THEY COULD DECREASE MEDICATION IN THEIR LIFE? A MEDICINE THAT THEY RESPOND TO IN THE BEGINNING THEY MIGHT NOT RESPOND TO LATER DOWN THE RODE. THE SIDE EFFECTS FOR ONE PERSON — THERE IS A LOT OF INDIVIDUALIZING TREATMENT. SOMETIMES IT DEPENDS ON WHAT THE DIAGNOSIS TURNS OUT TO BE. LESS OFTEN WE SEE PEOPLE WITH THE SAME COLLECTION OF SYMPTOMS AND THEY HAVE BEEN ON A LOT OF DRUGS. CERTAIN KINDS OF DRUGS CAN CAUSE THOSE SYMPTOMS. WE HAVE TO GET THEM OFF THE DRUGS AND THEN THEY STOP TAKING THEM AND ALL OF THOSE SYMPTOMS WERE CAUSED BY THE DRUG USE. LET’S TALK ABOUT THE STIGMA. THERE IS A STRONG SIGMA FOR PEOPLE SEEKING HELP FOR MENTAL ILLNESS. DO YOU THINK WE’LL BE ABLE TO GET OVER THAT HUMP? ABSOLUTELY. I THINK WE HAVE TO TAKE IT ONE DAY AT A TIME. I SEE CHALLENGES WITH THIS EVERY DAY. PEOPLE COMING IN TO SEE US, THEY HAVE BIAS. THERE IS HOPE THERE. I THINK THE THING THAT WE NEED TO DO IS EDUCATE THE COMMUNITY AND FAMILIES AND CLIENTS ABOUT TREATMENTS THAT WORK AND HOW TO GET THEM. HOW TO ADVOCATE FOR THEM. THOSE ARE SOME OF THE THINGS THAT WE HOPE TO DO OVER THE NEXT COURSE OF AN IF YOU YEARS TO MAKE A DIFFERENCE. HOW KEY IS HAVING FAMILY SUPPORT? HAVING A SUPPORT SYSTEM FOR THE FAMILY. FAMILY SUPPORT IS CRUCIAL. WE WERE TALKING JUST BEFORE WE CAME ON THE AIR, OUR CLIENTS WITH GOOD FAMILY SUPPORT ARE MORE SUCCESSFUL. THEY HAVE TO FACE THE REALITY THAT THEY HAVE A CHRONIC ILLNESS — IF THEY HAVE FAMILY WHO CAN HELP THEM ACCEPT THAT, IT MAKES ALL OF THE DIFFERENCE. WHEN YOU HAVE A CHILD WHO IS EXPERIENCING THE KIND OF SYMPTOMS THAT WE’RE TALKING ABOUT, THAT IS A CRISIS FOR THE FAMILY. THEY NEED HELP WITH THAT. TEACHING THEM THAT THIS IS A SERIOUS ILLNESS THAT CAN BE TREATED. LIKE DOCTOR POWELL SAID A LOT OF PEOPLE DON’T HAVE FIRSTHAND EXPERIENCE WITH THIS. IT’S SO MEANINGFUL TO HAVE A FAMILY MEMBER WHO HAVE SEEN PEOPLE — REALLY KNOW KIND OF WHAT IT FEELS LIKE TO HAVE THAT SUSPICION AIMED AT YOU. IT’S SCARY. IT’S NICE TO HAVE SOMEONE WHO KNOWS WHAT THAT IS LIKE. THEY HAVE A BETTER UNDERSTANDING THEY’RE MORE LIKELY TO FOLLOW THROUGH. EDUCATING THE PATIENTS, THEY REALLY DON’T KNOW WHAT IS GOING ON. THEY WOULD RATHER ADMIT THAT THEY HAVE A DRUG OR SUBSTANCE ABUSE PROBLEM. EDUCATION IS EXTREMELY IMPORTANT. THAT’S ONE OF THE FIRST THING THAT WE DO WHEN SOMEONE COMES IN THE DOOR. WE MAKE SURE THAT WE EXPLAIN WHAT IS GOING ON WITH THEIR FAMILY MEMBER. WE HAVE SOMEONE WHO CAN’T GET THEM HELP. WHAT SHOULD THEY DO? DON’T GIVE UP. BRING THEM INTO A WALK IN CLINIC. WE HAVE A LOT OF KNOWLEDGE ABOUT HOW TO USE THE MENTAL HEALTH SYSTEM. HOW TO ACCESS IF NECESSARY A COURT ORDER TO MAYBE PERHAPS — GET THEM ENGAGED, GET THEM ON MEDICINE AND OF COURSE THEY WOULD ENGAGE IN TREATMENT ON THEIR OWN. WE CAN USUALLY HELP A FAMILY MEMBER TO UNDERSTAND WHAT THEIR OPTIONS ARE. I CAN IMAGINE THAT WOULD BE A DAUNTING CHALLENGE FOR FAMILIES WHO NEVER EXPERIENCED IT OR DON’T KNOW WHERE TO GO FOR RESOURCES TO EVEN NAVIGATE THE SYSTEM. SO CONTACT A LOCAL PROVIDER. SO WHAT ABOUT THERAPY? ARE THERE ANY NEW THERAPIES ON THE HORIZON. I SEE YOU NODDING. A LOT OF GREAT THINGS. SO THE THINGS THAT WE’RE WORKING WITH FIRST EPISODE PSYCHOSIS. INDIVIDUAL RESILIENCY TRAINING. ALSO AN INTERVENTION THAT HAS BEEN WELL RESEARCHED. IT’S A VERY INTENSIVE INTERVENTION. SO YEAH, I THINK THERE ARE A LOT OF REALLY WELL RESEARCHED INTERVENTION. IN PARTICULAR EARLY EPISODE PSYCHOSIS THAT ARE WORKING. — AS LEARNED HOW TO DEAL WITH IT THAT PERSON CAN BECOME AN EMPLOYEE OF A MENTAL HEALTH CENTER. HEARING THE MESSAGE OF, WE CAN HELP YOU THROUGH THIS, IT SOUNDS DIFFERENT THAN A PSYCHOLOGIST SAYING IT. I’VE BEEN WHERE YOU ARE. SO WE WOULD LIKE THE OPPORTUNITY TO HAVE THAT MORE IN ARKANSAS. THE OTHER THING THAT WE KNOW THAT WORKS IS MEDICATION. THERE ARE NEW MEDICATIONS THAT COME ALONG. SOME THAT ARE INJECTABLE. INJECTABLE MEDICATION CAN HELP AT THE BEGINNING WHEN THEY’RE NOT SURE IF THEY HAVE TO TAKE THE MEDICINE EVERY DAY. AND THEY ONLY THINK THAT THEY ONLY HAVE TO TAKE IT ON THE DAYS WHERE THEY FEEL WORSE. BUT IF THEY’RE SCHEDULED TO GET AN INJECTION EVERY MONTH — IT CAN CUT DOWN ON LACK OF ADHERING TO THE TREATMENT. IS THAT EXPENSIVE? SOME ARE PRETTY EXPENSIVE. OVER ALL GENERALLY ALL OF THE HEALTH CARE PLANS COVER SOME OPTIONS FOR THAT. WE CAN BASICALLY ALWAYS GET SOMEONE ON A LONG ACTING INJECTABLE. THAT IS EXHIBIT SIDING TO HEAR THAT THERE ARE THOSE NEW THERAPIES THAT HAVE A LONG LASTING EFFECT. LET’S TALK QUICKLY BECAUSE WE’RE ALMOST OUT OF TIME. FUNDING. HOW ARE WE DOING IN ARKANSAS? ARE WE NEEDING TO DO BETTER? I THINK WE CAN ALWAYS DO BETTER. THERE PROBABLY ALWAYS ISN’T ENOUGH MONEY. MENTAL HEALTH AND BEHAVIORAL HEALTH IS ALWAYS UNDER FUNDED. I THINK WE’RE GETTING BETTER, BUT I THINK THAT WE CAN DO A LOT BETTER. WHEN IT COMES TO CASE MANAGEMENT, SUPPORTIVE SERVICES, THOSE ARE THE THINGS THAT WE STRUGGLE TO FUND. WHEN YOU SAY SUPPORTIVE EMPLOYMENT — GET PEOPLE REAL LIFE JOBS IN THE COMMUNITIES AND PROVIDE A SPECIALIST WHO CAN HELP THEM KEEP THAT JOB. THEY WOULD GET TO KNOW THE EMPLOYER. ARE WE SEEING PROGRESS IN THAT AREA? NOT YET. STILL WORKING. VERY QUICKLY. IF YOU DON’T FIND, DOCTOR IRWIN WE LIKE TO LEAVE PEOPLE WITH A SENSE OF HOPE. SO EXPRESS WHAT FAMILIES NEED TO KNOW. I GUESS, I’LL TELL YOU WHO GAVE ME HOPE WHEN LAST YEAR WHEN WE ALL STARTED LEARNING MORE ABOUT THIS, IS THAT IF WE IDENTIFY SOMEONE EARLY ON, AND WE CAN GET THEM IN. WE CAN GET THEM ON MEDICATION, THEY’RE RESPONSE TO THAT MEDICATION, THEY TELL US NOW, THE GOAL SHOULD NOT BE JUST TO DECREASE THE SYMPTOMS, IDENTIFY, GETTING THEM IN, KEEPING THEM ON THE MEDICINE. EVEN THOUGH THIS IS A SCARY DIAGNOSIS THE HOPE SHOULD BE THERE BECAUSE TREATMENTS ARE EFFECTIVE. THANK YOU FOR SHARING YOUR INSIGHTS ON THIS TOPIC. THANK YOU FOR WATCHING. GOOD NIGHT.

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