Treating First Episode Psychosis – John Kane, M.D.


John Kane, M.D.:>>In general, the first challenge
is to make the appropriate diagnosis to make sure that there is no other medical condition
or substance use that might be accounting for the psychotic signs or symptoms. And so, we have to take into consideration,
the presence of things like delusions, which are fixed, false beliefs or hallucinations,
hearing a voice when no one is speaking. But we also have to feel comfortable that those
symptoms are present with enough severity, intensity, and frequency to justify a diagnosis
of a psychotic disorder. We also, will often see that someone has had
a deterioration in functioning, either in school or at work or in terms of their social
relationships so all of those things are taken into consideration and these symptoms need
to be present for a certain amount of time before we would consider the diagnosis of
a specific illness. Unfortunately, when people begin to experience
psychotic symptoms, they often go for a long time before receiving treatment, uh, we call
that the “duration of untreated psychosis.” We believe that the longer it goes undiagnosed
and untreated, that the more difficult it is to achieve the outcomes that we like to
achieve. And in the data that we’ve analyzed so far, from the RAISE study, we did find
that those individuals who had a duration of untreated psychosis longer than 74 weeks,
were not as likely to benefit from our comprehensive care intervention as those patients who had
a shorter duration of untreated psychosis. So we do believe that the timing is important
and trying to provide the right treatment at the right time is really key. We do believe in, based on our findings so
far from RAISE, that coordinated and comprehensive specialty care can help improve the trajectory
of early phase psychosis and early phase schizophrenia. So we’d like to see it more broadly available There are many things that need to be available
to patients and families that we would put under the label of “comprehensive care.” And
what we mean by that is individual therapy, family therapy, family education, supported
employment, supported education to help someone get back to work or back to school. We can’t emphasize enough the importance of
the team-based approach Having those people available but also working
very closely with each other is key so that, an aspect of treatment that’s being conducted
by a family therapist is also shared with an aspect of treatment that’s being conducted
by an individual therapist and vice versa. So, having, having real team meeting where
people can get together and discuss, you know, all the information, um, whatever challenges
there are etc., and basically working on those problems together with the patient is very
important. And all of that should be tailored to the specific needs and goals of that individual
and his or her family. So, it’s, it’s a matter of both gathering information and also doing
education, helping a person deal with the fact that they’ve experienced the onset of
an illness, which can be, which can be serious. So, promoting, promoting hope and optimism
in recovery but also trying to be realistic about the need for treatment. We want to make sure that in that comprehensive
and coordinated care there’s also attention to, to medical issues to lifestyle issues.
We want to help people stop smoking. We want to help people, um, exercise, lead healthier
lives. What we’ve, what we’ve seen from data from many states across the US is that the
expected life span of someone with a chronic and severe mental illness is perhaps twenty-five
years shorter than the general population. And we also want to do something about that. I think it’s very important for people to
recognize that, this is an illness that we can treat. We can help people to achieve the
best possible outcome. We need to, to work with them. We need to discuss their, their
goals and their aspirations and try to help them to achieve those goals. Um. Treatment
may go on for periods of time. People need to stick with it. Um. But, I think, if we
can provide consistent, evidence-based care, coordinated team approach that, that we can
help them. And we can help them, um, get back to leading a normal life in the community.
And, I think, it’s also important to recognize that the more we can succeed in, in producing
better outcomes, we can also help to reduce some of the, some of the stigma that people
at times associate with mental illness.

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